A spatial analysis of COPD prevalence, incidence, mortality and health service use in Ontario.

BACKGROUND Risk factors for chronic obstructive pulmonary disease (COPD) include smoking, occupational exposure and air pollution, which vary geographically, but relatively little is known about how COPD varies spatially. DATA AND METHODS This population-based ecological analysis examines physician-diagnosed COPD prevalence, incidence, mortality, and health care services use in Ontario over a 10-year period. Data were mapped and analyzed at the sub-Local Health Integration Network level (n = 141). Comparative morbidity figures were calculated and analyzed for local clusters of high and low rates of COPD health and health service use outcomes. RESULTS A total of 722,494 individuals were identified as having COPD over the study period. Clusters of high rates in health outcomes and in most indicators of health service use emerged in northern parts of Ontario and in industrial and more rural agricultural areas. Clusters of low rates were centered on major urban and suburban areas. An exception was COPD-specific physician visits, which were lower in northern areas suggesting greater reliance on acute care. INTERPRETATION This study highlights the need for research focused on explaining the spatial patterns identified here.