Academic journal article Iranian Journal of Public Health

Spatial Hotspot Analysis of Acute Myocardial Infarction Events in an Urban Population: A Correlation Study of Health Problems and Industrial Installation

Academic journal article Iranian Journal of Public Health

Spatial Hotspot Analysis of Acute Myocardial Infarction Events in an Urban Population: A Correlation Study of Health Problems and Industrial Installation

Article excerpt


There has been an increasing frequency of cardiovascular disease (CVD) fatal report in developing countries and CVD remained a major and the first public health thread in Iran (1-3). Several studies have shown the significant relevance of CVDs and air pollution parameters such as PM10 and PM2.5 (4-7) and other air pollutants such as NOX, SO2, CO and O3 (8-11) and heavy metals like lead, mercury, selenium, cobalt, nickel and etc. (12-14).

The cardiovascular events (CVE) are not distributed randomly and the pattern can be shown spa- tially using Geographical Information System (GIS) (15, 16).

The city of Yazd is as populated as about 430000 people (17) and is becoming an industrial pole in Iran. Yazd industrial site installation is located in northwest of the city and consisted of different types of industries such as metal, chemical, electrical, textile, leather, nonmetal and pharmacy. However, some major industries like steel industries are still working outside the specific area and due to the city's development are getting closer to city's boundaries despite the strict rules of being further. According to climatology studies the main compass rose (windrose) of the region is northwest to southeast (18) that possible results would be carrying the pollutants all over the city in its pathway that may cause health problems.

The current study's objectives were to find any possible spatial patterns and hotspot of cardiovascular events and to perform a correlation study to find any possible relevance between CVE and location of industrial installation said above.

Materials and Methods

Hospital admission data

This ecological study was conducted in Yazd, Yazd Province, Iran during 2013, to assess the correlation of health problems and industrial installation. Hospitals admission data was supplied by hospital information system (HIS) in three main hospitals (Afshar, Shohadayekargar, and Shahidsadughi) with cardiovascular care units (CCU) during 2013. The International Classification of Diseases, Injuries, and Causes of Death (ICD, 10th revision) code I20 (acute myocardial infarction (AMI)) in the HIS was considered. This inclusion criterion was independent from outcome results (dead or alive).

These hospitals were taken since they are indicators of CVD admission in the city (19) and they are located in three separate locations and cover the city geographically the best. Afshar hospital admission records covered approximately 61.3% of whole admission records (267 of 437 records) since it is a specialized hospital for CVDs and the referenced hospital in the region. Date of admission, gender, age and patients address were included in the hospitals records.

It is nevertheless true to say that ascertaining the relevance of residence in which Yazd's inhabitants are living in with CVEs is difficult, since they tend to move about the city and the time spent at home is not permanent. Therefore, the data is assumed the fact that a remarkable amount of people's daily life is spent at home (e.g. at night or weekends).

Geographical information system database

GIS is a scientific tool for health studies, spatial distribution studies and the relevance investigations (20-22). Baseline city data, including city base maps and population blocks (based on population census of 2008), was supplied with the help of Yazd University Geography Department. The industrial distribution map was gained from the Yazd Industrial Installation Mapping Project, 2009. The admission data was entered to GIS as points according to the addresses that were gotten; each point represents an AMI event and includes date of admission, gender and age of the patient.

GIS technology was applied to create a fishnet over the city using GIS data management tools_ create fishnet. Fishnet cell-size (2km*2km) was obtained by testing different cell-sizes to find a minimum size with at least one event record. …

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