Investigation of Spatial Clusters of Chronic Cardiopulmonary Diseases in New York City

摘要

We aim to identify localized spatial clusters for four common cardiopulmonary diseases: Asthma, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), and stroke in New York City (NYC). We used the 500 Cities data from the Centers for Disease Control and Prevention, which provide prevalence estimates for chronic diseases, health behavioral and prevention measures at the census tract level for the 500 largest cities in the United States. Our analyses focused on NYC (n=2101 tracts) with additional sociodemographic data from the Census and pollution data from the Environmental Protection Agency. We first conducted a normal scan statistic (SatScan V9.5) using the crude prevalence with a weight adjustment based on the standard error of the prevalence. We also conducted a multivariate regression model using the four health outcomes as the dependent variables, with covariates being sociodemographic, unhealthy behavior and health care access, and pollution factors. Residuals from the model were used in SatScan for spatial cluster detection. Using the crude prevalence, we identified 3 and 2 high risk clusters for asthma and COPD, respectively. Using residuals, we found different cluster patterns. Comparisons of cluster locations and sizes showed a high residual risk cluster centered at 40.82N/73.96W with a 3.50-km radius (～ 100 tracts) in the west Harlem neighborhood for COPD, CHD, and stroke. The high residual cluster for asthma was centered at 40.64N/73.92W with an 11.54-km radius (n=1044 tracts), covering mostly Brooklyn and parts of Queens neighborhoods. The asthma cluster also overlapped with two small high risk clusters (<10 tracts) for COPD and stroke. Geographic variations of high and low risk clusters for chronic cardiopulmonary diseases exist in NYC even after adjusting for the usual suspected factors. The identified common clusters suggest intervention opportunities that may simultaneously benefit multiple chronic disease health outcomes.