Cardiovascular disease in Switzerland - health care, mortality and geographical pattern

SUMMARY Switzerland is facing an aging population and a growing amount of patients with chronic diseases. It is crucial to display health care processes and pathways, to identify inequalities and obstacles, and to point out possibilities for improvements of the Swiss health care system (e.g. increase efficiency). The introductory part of the thesis presents a brief description of the Swiss health care system, health services research and regional variation as well as an introduction of CVD and its epidemiological key figures, aetiology and treatments. This is followed by the description of the utilized methods and data, and the objectives of this thesis. The subsequent sections present the four articles included in this thesis. The first article focuses on a small area analysis on regional variation of avoidable hospitalisations in Switzerland including density of primary care physicians and specialists, rurality and hospital supply factors as explanatory variables in the analysis. Lower rates of avoidable hospitalisations were found in areas with very high supply of primary care physicians, increased avoidable hospitalisation rates in areas with more specialists and in areas with higher proportion of rural residents. The second article aims to examine whether emergency patients with acute ST-segment elevation myocardial infarction were adequately treated, i.e. according to the treatment guidelines, in Switzerland. Results show that older and female patients were less likely to receive revascularization which suggests that the treatment guidelines may not be uniformly applied in Switzerland. Similar to the first article, also in the third article a small area analysis was performed but this time investigating regional variation in costs at the end of life. Strongest associations of cost was found with cause of death, age and language region of the decedents. The strong spatial variation of costs could only partly be explained by the included covariates. Article four aims to examine the relationship of distance to different hospital types and mortality from AMI or stroke. We found that AMI mortality in the Swiss population 30 and older and stroke mortality in those 65 and above increased with distance to central and university hospitals, while adjusting for sociodemographic and economic characteristics of the population. The presentation of the four articles is followed by a discussion, which summarizes the main findings and the strengths and limitations of the presented articles. The thesis concludes with a discussion about the challenges for policy, practice and future research.

Homogeneous Spatial Units (HSU) - a Pan-European geographical basis for environmental and socio-economic modelling

The spatial data set delineates areas with similar environmental properties regarding soil, terrain morphology, climate and affiliation to the same administrative unit (NUTS3 or comparable units in size) at a minimum pixel size of 1km2. The scope of developing this data set is to provide a link between spatial environmental information (e.g. soil properties) and statistical data (e.g. crop distribution) available at administrative level. Impact assessment of agricultural management on emissions of pollutants or radiative active gases, or analysis regarding the influence of agricultural management on the supply of ecosystem services, require the proper spatial coincidence of the driving factors. The HSU data set provides e.g. the link between the agro-economic model CAPRI and biophysical assessment of environmental impacts (updating previously spatial units, Leip et al. 2008), for the analysis of policy scenarios. Recently, a statistical model to disaggregate crop information available from regional statistics to the HSU has been developed (Lamboni et al. 2016). The HSU data set consists of the spatial layers provided in vector and raster format as well as attribute tables with information on the properties of the HSU. All input data for the delineation the HSU is publicly available. For some parameters the attribute tables provide the link between the HSU data set and e.g. the soil map(s) rather than the data itself. The HSU data set is closely linked the USCIE data set.

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Mode of access: Internet.

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Disclosures on a precipitation indicator, moisture detector, vacuum ball valve, film strip printer, normal incidence interferometer, color sorter, and coaxial T. /

Mode of access: Internet.