The objective of this surveillance blog report is to examine the spatial distribution of deaths related to diabetes between 2010 and 2015 in Puerto Rico. Spatial epidemiology involves the analysis of the spatial/geographical distribution of disease incidence and its explanatory factors. The purpose of this technique is to produce maps that provide information on the spatial variation of disease occurrence in order to identify areas of particularly high risk.
Disease mapping results
The five municipalities with the highest observed diabetes-related deaths between 2010 and 2015 were San Juan, Ponce, Bayamón, Mayaguez, and Arecibo with 367, 255, 191, 159, and 131 deaths, respectively. Figure 1 is a map of observed cases by municipality that occurred during the 2010-2015 observation period. The five municipalities with the highest age-adjusted rates were Las Marías, Rincón, Sabana Grande, Aguada, and Yauco with 40.03, 38.55, 37.39, 35.91, and 34.71 deaths per 100,000 individuals, respectively. Figure 2 is a map of age-adjusted diabetes death rates by municipality during the 2010-2015 observation period. The five municipalities with the highest age-adjusted standardized mortality ratios during the 2010-2015 observation period were Las Marías, Aguada, Sabana Grande, Yauco, and Rincón with 2.19, 2.16, 1.85, 1.84, and 1.82 respectively. Figure 3 is a map of standardized mortality ratios by municipality.
The highest age-adjusted diabetes-related death rates in Puerto Rico seem to be centralized in the southwest corner of the island, as can be seen in Figure 2. The age-adjusted standardized mortality ratio (the ratio between the observed number of deaths and expected number of deaths) is also seen to be greater than 1.0 (i.e. more deaths than expected occurred) in many of these same municipalities in the southwest corner of the island (Figure 3). This type of spatial distribution study can be used to highlight regions or populations that are at particularly high risk of death due to diabetes. These findings indicate that further exploration for the reasons behind the differences in risk of diabetes-related death may be warranted.
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