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Hungary is one of the five countries in the World which were most affected by the pandemic in terms of registered COVID-19 mortality up to 2023. Our research aims to identify those socioeconomic variables that explain the geographical distribution of registered district-level COVID-19 mortality in Hungary. Using OLS and spatial regression, we found that the higher share of elderly people and respiratory death rate were associated with a more severe mortality burden. Educational attainment was negatively associated with COVID-19 mortality. Variables related to healthcare access were not found to be significantly associated with district-level COVID-19 mortality. Our results indicated that the spatial term of COVID-19 mortality is significant. Positive spatial autocorrelation can be observed in some less developed districts and a few inner peripheral areas where COVID-19 mortality was relatively high, and relatively developed areas like the agglomeration area of the capital in which COVID-19 mortality was low.

Az elmúlt években felértékelődött a globális klímaváltozás regionális hatásainak kutatása, s ezzel párhuzamosan az időjárási szélsőségek okozta természeti veszélyhelyzetek társadalmi következményeinek minél pontosabb feltérképezése. Helyi szinten a természeti kockázatokkal összefüggésben a társadalom növekvő sérülékenysége jelent kihívásokat, így egyre nagyobb az igény a társadalom és a gazdaság részéről a felkészüléssel és megelőzéssel kapcsolatos információkra. Az Európai Unió támogatásával több olyan nemzetközi projekt valósult meg a Kárpát-medencében, amely különböző szempontok alapján vizsgálja a klímaváltozás okait és hatásait (pl. CARPATH CC, korábban ADAM, CECILIA, ENSEMBLES, PRUDENCE stb.). Ezek közül a SEERISK projekt kilenc közép- és délkelet-európai ország részvételével működik 2012 óta, és fő célkitűzése egységes kockázatértékelési módszertan kialakítása a klímaváltozás következtében felerősödő természeti veszélyhelyzetekre való megfelelő katasztrófavédelmi felkészülés céljából. A tanulmány elsődleges célja bemutatni azokat az eredményeket és tapasztalatokat, amelyek közös alapokra helyezhetik a klímaváltozással kapcsolatos kockázatok felmérését, térképi ábrázolását, az intézményi és lakossági felkészülést, a természeti veszélyhelyzetek kezelését. Az eredmények feldolgozása mellett részletesen ismertetjük a kockázatértékelési és a közösségi klímaadaptációs képesség elemzésére irányuló társadalomtudományi módszereket.

Az egészségi állapotban jelen lévő egyenlőtlenségek csökkentésének egyik hatékony eszköze az egészségügyi szolgáltatásokhoz való hozzáférés feltételeinek és a hozzáférés esélyegyenlőségének biztosítása. Az egészségügyi ellátáshoz való hozzáférés vizsgálatában a közfinanszírozott szürkehályogműtétek 2008. évi adatait vizsgáltuk. A kutatás során arra voltunk kíváncsiak, hogyan oszlanak meg az ellátási kapacitások és az ellátási típusok a szolgáltatást végző intézmények között, illetve milyen domináns útvonalak különíthetők el az igénybevételhez kapcsolódó betegmobilitásban. Regionális és kistérségi esettanulmányunkban külön elemeztük, hogy egyrészt az egészségügyi intézmények elérhetősége milyen mértékben van hatással az igénybevételre, másrészt mekkora különbség tapasztalható az utazási távolságban, időtartamban és költségekben akkor, amikor a beteg nem a lakóhelyéhez legközelebbi intézményben vette igénybe a műtéti szolgáltatást. A lakóhelytől függően nagy egyenlőtlenséget tapasztaltunk az intézmények elérhetőségében. A műtétek során a betegek nagy része nem a lakóhelyéhez legközelebbi intézményt kereste fel, ezzel vállalva az utazási és kiadási többletet. Közülük sokan a területi ellátási kötelezettség alapján, tehát a szabályokat követve utaztak a távolabbi ellátó intézménybe. A lakosság egészségügyi ellátással való elégedettségének növelésében a jövőben azt is vizsgálni kell, hogy milyen további tényezők befolyásolják a betegek orvos- és intézményválasztását. A tanulmány javaslatokat fogalmaz meg a térségi egészségügyi ellátórendszerek kialakításához, valamint kísérletet tesz egy olyan módszertan kidolgozására, amely segítségül szolgálhat a szakpolitikai döntéshozatalhoz.

A tanulmány célja a magyar egészségügy átalakítása intézményi és területi vonatkozású következményeinek bemutatása. A struktúraátalakítás során az új ellátási hierarchiában a kórházi kapacitások meghatározása régiók szerint történik, így a területi különbségek földrajzi értelemben is vizsgálhatóvá válnak. Az egészségügy működésében és felépítésében tapasztalható változások közép- és hosszú távon szolgálják a hazánkra jellemző egészségügyi egyenl őtlenségek mérsékl ődését és a konfliktusok megoldását.

"The Geographies of COVID-19: Geospatial Stories of a Global Pandemic" is a book reviewed in the Hungarian Geographical Bulletin, focusing on the ongoing impact of the COVID-19 pandemic. The book explores the relationship between health and place from a global perspective, analyzing the geographic features of the pandemic. It provides case studies and examples of geospatial analysis to understand the inequalities and vulnerabilities experienced in different regions around the world. The book aims to help readers comprehend the complexity of the pandemic's geographies and its multi-dimensional consequences, making it a valuable resource for researchers, professionals, and students interested in health geography and GIS applications. [Extracted from the article]

The availability of health care services is an important issue, however, improving availability of health care services does not necessarily mean better accessibility for everybody. The main aim of this study is to find out how better availability in the care of acute myocardial infarction vary with accessibility of patients’ geographical location within Hungary. We applied statistical analysis and interview techniques to unfold the role of spatiality in the conditions of access to health care. Results of statistical analysis indicate significant health inequalities in Hungary. Decreasing national mortality rates of acute myocardial infarction, has been coupled by increasing spatial inequalities within the country especially at micro-regional level. According to in-depth interviews with local health care stakeholders we defined factors that support access to health care as well as important barriers. The supporting factors are related to the improvement of availability (i.e. infrastructural developments), while geographical distance, lack of material and human resources, or low level of health literacy proved to be the most relevant barriers. Main conclusion is that barriers to accessibility and availability are not only spatial but are also based on individual stages of acute myocardial infarction care. The development of cardiac catheter centres in Hungary has improved the short-term chances of infarction survival, but long-term survival chances have worsened in recent years due to deficiencies in rehabilitation care as well as low level of health literacy.

Hungary is one of the five countries in the World which were most affected by the pandemic in terms of registered COVID-19 mortality up to 2023. Our research aims to identify those socioeconomic variables that explain the geographical distribution of registered district-level COVID-19 mortality in Hungary. Using OLS and spatial regression, we found that the higher share of elderly people and respiratory death rate were associated with a more severe mortality burden. Educational attainment was negatively associated with COVID-19 mortality. Variables related to healthcare access were not found to be significantly associated with district-level COVID-19 mortality. Our results indicated that the spatial term of COVID-19 mortality is significant. Positive spatial autocorrelation can be observed in some less developed districts and a few inner peripheral areas where COVID-19 mortality was relatively high, and relatively developed areas like the agglomeration area of the capital in which COVID-19 mortality was low. [ABSTRACT FROM AUTHOR]

This article interprets the spatial dimension of health inequalities in Hungary through the connection between unemployment and life expectancy from the national level to the level of micro-regions and settlements with a special emphasis on cities. The article highlights the correlation between unemployment and average life expectancy at birth based on regional statistical databases. The results of quantitative questionnaires (n = 545) and qualitative in-depth interviews (n = 26) are also presented in order to explore the effect of the crisis on urban populations residing in major Hungarian cities. The correlation between unemployment and life expectancy becomes stronger during crisis periods. Our findings indicate not only that the labour-market position and level of income are important from a health point of view, but also that the level and growth of existing social and health inequalities strengthen the effects of the crisis on health. It is evident that, in Hungary, direct effects of the crisis on health inequalities exacerbate regional differences. Cities can counterbalance the unfavourable health effects of the crisis and they may successfully contribute to decreasing health inequalities.

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The shortage and uneven geographic distribution of health workers is considered a severe global problem nowadays. Recent studies examining inequalities in health workforce supply at various spatial scales suggest that health workers' geographic distribution follows a core-periphery pattern as the more developed areas are generally better supplied with health labour than the less developed ones. Here, we explore the regional patterns and temporal changes of the geographic distribution of physicians in the European Union (EU) at the Nomenclature of territorial units for statistics (Nomenclature des unités territoriales statistiques - NUTS) 2 level between 2006 and 2018. We also compare the levels of concentration and inequality in the geographic distribution of physicians, economic development, and health outcomes. We utilise a mix of statistical methods such as descriptive statistics, indices of concentration and inequality, and bivariate correlation analysis based on Eurostat data. Our results provide evidence that the regional distribution of physicians in the EU shows a core-periphery pattern: NUTS regions with capital cities or metropolitan areas have more physicians. In addition, the regional patterns of the distribution of physicians in the EU are stable in time, and their geographic concentration is strengthening in the long run. Our results also suggest that there is a positive relationship between the geographic distribution of physicians and health outcomes; however, this relationship needs further investigation. [ABSTRACT FROM AUTHOR]

The COVID-19 epidemic first appeared at the end of 2019, and it became a worldwide pandemic in the first quarter of 2020. The new coronavirus pandemic made it clear that infectious diseases are able to significantly influence morbidity and mortality data of countries in the 21st century, too. There are many complex and profound socio-economic consequences of the restrictions in relation to the coronavirus pandemic. This epidemic also resulted in an economic crisis with multiple effects on the economy and society. It is said that spatiality has a determinative role in the geographical spreading of the pandemic and on regional differences of the economic crisis. The scope of this paper is to compare the most important features and regional inequalities of the epidemic waves in Hungary based on epidemiological data. Besides statistical analysis, the study examines short-, medium- and long-term effects of the pandemic on health and health care, too. The literature review presents some regional features of the coronavirus epidemic, and it also defines the role of this pandemic on non-communicable diseases for the future. The used content-analysis investigates the Hungarian restrictions and their regional relevance. The main results of our research show that there are marked differences between the three epidemic waves in Hungary based on the number of confirmed cases and regional inequalities regarding restrictions. There was a longer interim period during the summer between the two epidemic waves of spring and autumn of 2020. On the other hand, the longer improving tendency of the second wave suddenly stopped in mid-February 2021 resulting in a third epidemic wave in Hungary. The first wave was a 'flat curve' while the second wave resulted in an epidemic plateau. The third wave started during the decreasing process of the second wave. The first wave was more linked to geographical (Budapest capital city and Pest county) and institutional (hospitals, nursing homes) hotspots, however in the second and third wave nationwide infection ranges became more determinative. The results of our research call the attention to the regional relevance of restrictions regarding the pandemic. When this paper was finished, on the 4th of March 2021, the pandemic did not end yet in Hungary, so its evaluation can not be complete at this time. The ascending trend of the third wave of the COVID-19 pandemic is due to the spreading of new coronavirus variants and mutations. [ABSTRACT FROM AUTHOR]

In times of epidemics and humanitarian crises, it is essential to translate scientific findings into digestible information for government policy makers who have a short time to make critical decisions. To predict how far and fast the disease would spread across Hungary and to support the epidemiological decision-making process, a multidisciplinary research team performed a large amount of scientific data analysis and mathematical and socioeconomic modeling of the COVID-19 epidemic in Hungary, including modeling the medical resources and capacities, the regional differences, gross domestic product loss, the impact of closing and reopening elementary schools, and the optimal nationwide screening strategy for various virus-spreading scenarios and R metrics. KETLAK prepared 2 extensive reports on the problems identified and suggested solutions, and presented these directly to the National Epidemiological Policy-Making Body. The findings provided crucial data for the government to address critical measures regarding health care capacity, decide on restriction maintenance, change the actual testing strategy, and take regional economic, social, and health differences into account. Hungary managed the first part of the COVID-19 pandemic with low mortality rate. In times of epidemics, the formation of multidisciplinary research groups is essential for policy makers. The establishment, research activity, and participation in decision-making of these groups, such as KETLAK, can serve as a model for other countries, researchers, and policy makers not only in managing the challenges of COVID-19, but in future pandemics as well. [ABSTRACT FROM AUTHOR]

The availability of health care services is an important issue, however, improving availability of health care services does not necessarily mean better accessibility for everybody. The main aim of this study is to find out how better availability in the care of acute myocardial infarction vary with accessibility of patients' geographical location within Hungary. We applied statistical analysis and interview techniques to unfold the role of spatiality in the conditions of access to health care. Results of statistical analysis indicate significant health inequalities in Hungary. Decreasing national mortality rates of acute myocardial infarction, has been coupled by increasing spatial inequalities within the country especially at micro-regional level. According to in-depth interviews with local health care stakeholders we defined factors that support access to health care as well as important barriers. The supporting factors are related to the improvement of availability (i.e. infrastructural developments), while geographical distance, lack of material and human resources, or low level of health literacy proved to be the most relevant barriers. Main conclusion is that barriers to accessibility and availability are not only spatial but are also based on individual stages of acute myocardial infarction care. The development of cardiac catheter centres in Hungary has improved the short-term chances of infarction survival, but long-term survival chances have worsened in recent years due to deficiencies in rehabilitation care as well as low level of health literacy. [ABSTRACT FROM AUTHOR]

The paper is based on a case study which is the part of a research project (No. 119574). This research aims to analyse regional differences of health inequalities in Hungary addressed it to the role of access to health care. The examinations contain both of quantitative and qualitative techniques as mixed method. To measure health inequality and its regional differences morbidity and mortality data of acute myocardial infarction was used. To define the conditions of accessibility health care of infarction was applied. The theoretical background of this research is based on a model ‘5A’. The most important results of statistical analysis can strengthen a paradox situation: marked improvement of mortality has happened in the last 15 years, but the level of morbidity and mortality is still high internationally. On the other hand, there are notable regional differences within the country. Primary experiences of made semi-structured interviews can highlight the role of availability, lack of human capacity and weaknesses of patient education in the barriers of access to health care. Moreover, there is remarkable difference between the opinion of medical workers and patients about the relevant influencing factors of accessibility. All results and experiences are suitable to make some proposals for evidence based decision-making. Next step of the research is making expert interviews with important stakeholders of the Hungarian health policy. [ABSTRACT FROM AUTHOR]

The N-methylquinolinium tetrafluoroborate (NMQ(super +1))-sensitized photolysis of the erythro-1,2-diphenyl-2-arylsulfanylethanols is investigated in MeCN under laser flash and steady-state photolysis. The formation of sulfide radical cations in the monomeric (lambda(sub max)=520-540nm) and dimeric form (lambda(sub max)=720[right arrow] 800 nm) was observed within the laser pulse under laser irradiation.

Global climate change has an impact on health regarding its morbidity and mortality data as well as on the health care system. The connection between climate change and health has many serious consequences. There are determinative socioeconomic inequalities regarding climate vulnerability. The relevant solution of these challenges is an important task for national and local policies. The number, frequency and period of heat waves will increase in Europe as well as in Hungary in the future. Our project is based on this fact, and the main aim of this research was to apply a climate vulnerability model to analyse health risks and public health consequences of heat waves. This study presents the indicators of exposure, sensitivity and adaptive capacity, and explains the method of climate vulnerability model, too. Using climate vulnerability examination could help us to define regional differences at microregional level, to assign the most vulnerable areas in the country, and to discover typical spatial patterns of climate vulnerability. Summing up, climate vulnerability regarding heat waves has special spatial distribution in Hungary according to the increasing vulnerability among different parts of the country. There are some regions where higher level of exposure goes together with more sensitivity and lower level of adaptive capacity which can result in more or most vulnerability. These regions have special geographical position within Hungary. Stronger climate awareness and improving adaptive conditions will be a priority for making new health care strategies in the near future. [ABSTRACT FROM AUTHOR]

Access to health care is one of determinative factors in understanding health inequalities. It is not an easy task to define it, because its conceptualisation and measuring depend on different approaches and socio-economic characteristics. In our three year course research project the main aim is to analyse the Hungarian health inequality and its regional differences related to the role of access to health care. The multi-factorial way in determination of barriers in access to health care means using mixed method with combination of quantitative and qualitative techniques. Acute myocardial infarction is one of non-communicable cardiovascular diseases, which was the example in the case study of our project. This was used to study the connection among accessibility, inequality and spatiality. The primary results of statistical analysis confirm a paradox situation in Hungary based on improving health with increasing inequalities. The most important experiences of making semi-structured interviews with medical stakeholders and patients can discover individual and institutional influencing factors in access to health care. The aim of this paper is to interpret basic theoretical and empirical framework of our research project with its most important results. In addition, many experiences of our examinations are suitable for making proposals for evidence based policy-making. [ABSTRACT FROM AUTHOR]

The paper conceptually identifies the socio-economic consequences of climate change with health effects of heat waves. It is virtually certain that the length, frequency and intensity of heat waves will increase in the future. A heat wave is generally defined as a period of several days to weeks of abnormally hot weather. The number of heat extremes has substantially increased across Europe, but temperature thresholds for health impacts differ according to regions and seasons. The health effects of extreme heat waves regarding climate change with its consequences in health care can also be detected in Hungary. The risk of heat-related illness and mortality exists for the whole population, but there are some vulnerable groups. Public health measures need to be implemented to prevent heat-related illness and mortality in local community and institutions. The aim of this paper is to present the most important results of a research project which were made by qualitative methods. The article contains four main chapters. The primary object is to define the role of climate change in socioeconomic processes. Secondly, there are some useful information about the research project and its tasks to analyse local public health consequences of climate change. Thirdly, all experiences of qualitative examinations are based on interviews and contant-analysis. Lastly, the highlights of this paper can help to make some proposals for local decision-making. [ABSTRACT FROM AUTHOR]

Copyright of Területi Statisztika is the property of Hungarian Central Statistical Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The interpretation of the social factors defining health inequalities presumes that during a crisis, not only does the labour market position and the level of income count from a health point of view, also the level and growth of already existing social and health inequalities count. How did the economic regime and the appearance of unemployment influence life chances after 1990? Do regional differences unequivocally prove a western- eastern split in health inequalities? Does favourable socio-economic environment and low unemployment always mean better life chances? To answer these questions, we used regional analytical methods. In order to explain cause-and-effect correspondences, we justified the link between unemployment and life chances with regression calculations. The micro-regional difference between the most and least favourable average life expectancy at birth is 7.1 years, which is larger than in the counties (3.1 years). The connection between unemployment and life expectancy is of medium-strength on the level of micro-regions, and from 2009 to 2010 it has become stronger, especially in the case of males' life span. Fundamentally, socio-economic environment and quality of life influence health conditions; therefore, the current task is to interpret the inequalities of healthrelated quality of life within Hungary, from the national level through the county level to the level of microregions and settlements. [ABSTRACT FROM AUTHOR]

It is unquestionable that the crisis has been taking effect on the people's state of health, although the impacts are complex. How did the crisis of transition result health deterioration for those social groups who were most affected by unemployment and poverty at the beginning of the 1990s? Does the present crisis have effects on health and life expectancy at all? The main goal of this study is to emphasize primarily the relationship between unemployment and life span, and is also to analyse the spatial dimension of health inequalities during the terms of crisis in Hungary. [ABSTRACT FROM AUTHOR]

Abstract: Physical activity has a great influence on our health. Because of the environmental prerequisites of physical activity and health it would be important to explore what children think of this relationship. Therefore, this paper aims to highlight the connection among environment/urban planning and physical activity and the importance of them for health. The primary goal of the present study was to determine beliefs and interconnections between environment and regular physical activity between Grade 4 and Grade 5 children living in different urban settings. Subjects included young children aged 9–11 (N =448) from six primary schools in Hungary representing three residential location types (capital city, medium-sized and small towns). Interconnections among the children''s environment, health/illness and physical activity were assessed through a questionnaire based upon the ‘draw-and-write’ technique. Our findings showed a close connection between urban children''s images of physical activity and the environment. Children''s mentions of sports equipment, place, or institution suitable for physical activity were frequently in connection with the word ‘environment’. The children''s drawings and written answers that were analyzed in this study support, within each type of the residential location examined, that there is an opportunity to engage in satisfactory leisure time physical activity. [Copyright &y& Elsevier]

After a brief introduction describing the urban environment of Budapest, the local differences in the quality of life are characterized by means of an index derived from the broadest set of variables that are available for the 23 districts of the Hungarian capital. The concept of HDI is also adapted to the urban districts and by regressing its value against property prices, an extremely strong correlation could be revealed. Out of the components of HDI, the education level of the resident population appears to be most closely connected with the property values. By disaggregating the real estate transactions database of the years 2005 and 2006 according to street addresses in the hilly Buda districts, it is possible to assess the impact of altitude on the residential property values. The mean price related to unit floor area of the apartments reaches a peak at a height of 200 meter above sea level where favourable environmental attributes, like proximity to open space and visual amenities are coupled with prestigeous image and high status of the population. Beyond the natural endowment, the scarcity of land available for housing in the Buda Hills and high construction costs due to the physiography are also capitalised in the property values. Conclusions bearing relevance to urban planning are summarized in a SWOT analysis at the end of the paper. [ABSTRACT FROM AUTHOR]

This paper examines the spatial dynamics and regional distribution of the novel coronavirus epidemic in Hungary in an effort to obtain a deeper understanding of the connection between space and health. The paper also presents comprehensive epidemiologic data on the spatiotemporal spread of the COVID-19 pandemic in terms of the epidemic waves. Following a comparison of the growth rates of infection numbers, the current study explores the geographical dimension of the three pandemic waves. The partial transformation of spatial characteristics during the three epidemic waves is among the most important results found. While geographical hotspots influenced the first wave, newly confirmed coronavirus cases in the second and third waves were due to community-based epidemic spreading. Furthermore, the western-eastern spatial relation and the core-periphery model also affected the regional distribution of new cases and deaths in the initial two waves. However, a new spatial pattern - realised by the northern-southern spatial orientation - appeared during the third wave. The outputs of this paper offer feasible suggestions for evidence-based policymaking in pandemic prevention, mitigation, and preparedness.

One form of climate change vulnerability is the increase in the number, frequency and length of heat waves related to temperature rise. The protection against the health and sanitary risks of heat waves will pose a major challenge at national, regional, as well as local level in the future. The aim of the study is to present the main results of an assessment of climate change vulnerability conducted in a research project. Through statistical analyses, vulnerability was calculated based on the exposure, sensitivity and adaptive capacity at district level (LAU1), which is a complex information carrier about the vulnerability of population and institutions to heat waves. The territorial differences of vulnerability proved the West-East division of the country, but the centre-periphery relation also plays role in the development of territorial pattern. Based on statistical examinations it is ascertainable, that, in total, 42.5% of the country’s territory, where currently 39.5% of the population live, is severe and extreme vulnerable to the effects of climate change. The main results of the research can also be used as suggestions for the local decision-making related to the preparation for and adaptation to the health effects and sanitary consequences of heat waves.

Avtorja v članku obravnavata prostorsko razsežnost neenakosti v zdravju na Madžarskem na podlagi povezave med brezposelnostjo in pričakovano življenjsko dobo na državni ravni ter vse do ravni mikroregij in naselij, pri čemer je poseben poudarek na mestih. Poudarjata povezavo med brezposelnostjo in povprečno pričakovano življenjsko dobo ob rojstvu na podlagi regionalnih statističnih podatkovnih baz, poleg tega predstavita tudi ugotovitve kvantitativnih vprašalnikov (n = 545) in kvalitativnih poglobljenih intervjujev (n = 26). Na tej podlagi obravnavata vpliv gospodarske krize na prebivalstvo večjih madžarskih mest. Povezava med brezposelnostjo in pričakovano življenjsko dobo se v času krize poveča. Izsledki avtorjev kažejo, da sta položaj na trgu dela in raven prihodkov pomembna z vidika zdravja, raven in rast obstoječih družbenih in zdravstvenih neenakosti pa povečata tudi vpliv gospodarske krize na zdravje ljudi. Na Madžarskem neposredni vplivi gospodarske krize na neenakosti v zdravju še povečujejo regionalne razlike. Mesta lahko uravnovesijo neugodne vplive krize na zdravje in uspešno prispevajo k zniževanju neenakosti v zdravju.

Introduction: Several international studies have already confirmed the importance of the socioeconomic status of acute myocardial infarction patients in terms of patient care and prognosis. To our knowledge, a nationwide examination of this kind has not yet taken place in Hungary. The investigation of this problem field was made possible by the fact that from January 1, 2014, all healthcare providers must record the data of patients treated with a diagnosis of acute myocardial infarction in the database of the Hungarian Myocardial Infarction Registry (HUMIR)., Objective: In this study, the authors searched for an answer to whether the complex development index (CDI) in Hungary's 174 districts and 23 capital districts influences the treatment and prognosis of acute myocardial infarction patients., Method: Based on the CDI worked out by the Hungarian Central Statistical Office, the authors divided the Hungarian districts into low (CDI_L), medium (CDI_M) and high (CDI_H) CDI groups according to their values. They examined the incidence, hospital treatment and prognosis of acute myocardial infarction in these administrative-territorial units. The HUMIR included 66,253 patients treated by myocardial infarction between 2015 and 2019. Their place of residence could be identified based on the zip code and in which district it was located. In the examined population, 29,101 patients with ST-elevation (STEMI) and 37,152 without ST-elevation (NSTEMI) received treatment for acute myocardial infarction., Results: In the population over 15 years of age, the age-standardized incidence of STEMI was 68.8 per 100,000 inhabitants a year in the CDI_L group and 52.7 per 100,000 inhabitants a year in the CDI_H group. Almost the same values were found in all three CDI subgroups of NSTEMI incidence (69.5 and 67 per 10,000 inhabitants a year). The frequency of percutaneous coronary intervention in the case of STEMI was higher than in NSTEMI, but within the groups, CDI did not influence the performance of this treatment. In the case of STEMI, the rates of patients who underwent percutaneous coronaria intervention in all three CDI subgroups (CDI_L, CDI_M, CDI_H) were 83.5%, 83.7%, 83.5%, while in the case of NSTEMI they were 57.4%, 57.7%, 57.3%. The authors applied a Cox multivariate regression analysis to examine myocardial infarction mortality. The CDI did not affect the 30-day mortality rates in the case of any myocardial infarction: the hazard ratio (HR) values were 0.906 and 0.914 (p = 0.04659; p = 0.04686) in the case of STEMI, while 1.067 and 1.001 (p = 0.16520; p = 0.98933) in the case of NSTEMI. In the case of a STEMI diagnosis, the risk of the 30-364-day and the 1-year mortality in the subgroup of CDI_H was significantly lower (HR = 0.822 and 0.816) than in the subgroup of CDI_L (p = 0.00096 and p = 0.00001). In the case of NSTEMI diagnosis, the authors found a difference in the risk of beyond 1-year mortality by comparing the districts in the subgroup of CDI_L with the districts in CDI_H: in the latter case, the HR of the mortality was 0.876, which was significantly lower (p = 0.00029) than in the subgroup of CDI_L., Conclusion: The CDI has independent prognostic significance in determining the late prognosis of acute myocardial infarction patients. Orv Hetil. 2022; 163(47): 1862-1871.