title: Regional variation of nonrural pediatric ambulance transport rates: an ecological study.
abstract: OBJECTIVE
  To determine the relationship of pediatric transport rates per hundred thousand pediatric population (RATE) to socioeconomic status (SES) factors and also mortality in Emergency Medical Services (EMS) systems.
  
  
  METHODS
  Retrospective ecological study.
  
  
  METHODS
  Four EMS Medical Control Authorities (MCAs) in Michigan.
  
  
  METHODS
  Patients (3,792), 0-19 years of age, responded to as a nonscheduled emergency response and transported to a hospital by ambulance.
  
  
  METHODS
  RATE, economic status (INCOME), private transportation status (VEHICLE), educational status (EDUC), primary care physician availability (PHYS), and EMS disease death rate (EMSDD) were determined for each MCA and analyzed using Spearman rank correlation.
  
  
  RESULTS
  RATE between MCAs varied from 325 to 750. RATE was highest in the most urban MCA: its 0-4 RATE was fourfold larger than any other MCA. INCOME, EDUC, and VEHICLE were inversely correlated with transport rate: -1.00, -1.00, -1.00; P < 0.001. Rate was positively correlated with EMSDD: 1.00; P < 0.001.
  
  
  CONCLUSIONS
  Substantial variation in RATE between MCAs may be primarily due to the high 0-4 transport rate in the most urban MCA. This study also suggests that higher pediatric EMS system utilization rates may be correlated to higher mortality and also to unavailability of personal transportation.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor 48109-0303, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Maio
authors.forename: P
authors.initials: P
authors.lastname: Tedeschi
authors.forename: R
authors.initials: R
authors.lastname: Swor
authors.forename: J
authors.initials: J
authors.lastname: Krohmer
authors.forename: R
authors.initials: R
authors.lastname: Ferrel
authors.forename: D L
authors.initials: DL
authors.lastname: Jacques
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008824:Michigan; D009026:Mortality; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*