title: The distance to community medical care and the likelihood of hospitalization: is closer always better?
abstract: OBJECTIVE
  This study examined the influence that distance from residence to the nearest hospital had on the likelihood of hospitalization and mortality.
  
  
  METHODS
  Hospitalizations were studied for Maine. New Hampshire, and Vermont during 1989 (adults) and for 1985 through 1989 (children) and for mortality (1989) in Medicare enrollees.
  
  
  RESULTS
  After other known predictors of hospitalization (age, sex, bed supply, median household income, rural residence, academic medical center, and presence of nursing home patients) were controlled for, the adjusted rate ratio of medical hospitalization for residents living more than 30 minutes away was 0.85 (95% confidence interval [CI] = 0.82, 0.88) for adults and 0.78 (95% CI = 0.74, 0.81) for children, compared with those living in a zip code with a hospital. Similar effects were seen for the four most common diagnosis-related groups for both adults and children. The likelihood of hospitalization for conditions usually requiring hospitalization and for mortality in the elderly did not differ by distance.
  
  
  CONCLUSIONS
  Distance to the hospital exerts an important influence on hospitalization rates that is unlikely to be explained by illness rates.
authors.affiliation: Department of Pediatrics, Dartmouth Medical School, Hanover, NH 03755-3862, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Goodman
authors.forename: E
authors.initials: E
authors.lastname: Fisher
authors.forename: T A
authors.initials: TA
authors.lastname: Stukel
authors.forename: C
authors.initials: C
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000600:supply & distribution*; D003953:Diagnosis-Related Groups; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009026:Mortality; D009511:New England / Q000453:epidemiology; D016012:Poisson Distribution; D014195:Travel; D014481:United States