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. 2014 May 20;9(5):e98170.
doi: 10.1371/journal.pone.0098170. eCollection 2014.

Geographic disparity in chronic obstructive pulmonary disease (COPD) mortality rates among the Taiwan population

Ta-Chien Chan  1 , Po-Huang Chiang  2 , Ming-Daw Su  3 , Hsuan-Wen Wang  4 , Michael Shi-yung Liu  5
Affiliations

Geographic disparity in chronic obstructive pulmonary disease (COPD) mortality rates among the Taiwan population

Ta-Chien Chan et al. PLoS One. .

Abstract

Chronic obstructive pulmonary disease (COPD) causes a high disease burden among the elderly worldwide. In Taiwan, the long-term temporal trend of COPD mortality is declining, but the geographical disparity of the disease is not yet known. Nationwide COPD age-adjusted mortality at the township level during 1999-2007 is used for elucidating the geographical distribution of the disease. With an ordinary least squares (OLS) model and geographically weighted regression (GWR), the ecologic risk factors such as smoking rate, area deprivation index, tuberculosis exposure, percentage of aborigines, density of health care facilities, air pollution and altitude are all considered in both models to evaluate their effects on mortality. Global and local Moran's I are used for examining their spatial autocorrelation and identifying clusters. During the study period, the COPD age-adjusted mortality rates in males declined from 26.83 to 19.67 per 100,000 population, and those in females declined from 8.98 to 5.70 per 100,000 population. Overall, males' COPD mortality rate was around three times higher than females'. In the results of GWR, the median coefficients of smoking rate, the percentage of aborigines, PM10 and the altitude are positively correlated with COPD mortality in males and females. The median value of density of health care facilities is negatively correlated with COPD mortality. The overall adjusted R-squares are about 20% higher in the GWR model than in the OLS model. The local Moran's I of the GWR's residuals reflected the consistent high-high cluster in southern Taiwan. The findings indicate that geographical disparities in COPD mortality exist. Future epidemiological investigation is required to understand the specific risk factors within the clustering areas.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Temporal trend of age-adjusted mortality of chronic obstructive pulmonary disease in Taiwan, 1999–2007.
Figure 2
Figure 2. Geographical distribution of age-adjusted mortality of chronic obstructive pulmonary disease in the township level of Taiwan, 1999–2007.
(A) Male (B) Female.
Figure 3
Figure 3. The residual maps after geographically weighted regression.
(A) Male (B) Female.
Figure 4
Figure 4. Local Moran’s I of the residuals by geographically weighted regression.
Figure 5
Figure 5. Geographical distributions of the selected significant predictors of male COPD mortality.
(A) Male smoking rate, (B) Percentage of male aborigines, (C) CO, (D) PM10.
Figure 6
Figure 6. Geographical distributions of the selected significant predictors of female COPD mortality.
(A) Female smoking rate, (B) Percentage of female aborigines, (C) CO, (D) PM10.
See this image and copyright information in PMC

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