Relationship between travel time to the nearest hospital and survival from ruptured abdominal aortic aneurysms: record linkage study.
BACKGROUND
There is currently a trend in Britain to concentrate specialist services in a smaller number of hospitals in order to improve outcomes. However, for rapidly life-threatening conditions such as ruptured abdominal aortic aneurysms (RAAAs), the resulting increased travel time to hospital might adversely affect survival. This study aimed to evaluate the relationship between travel time to the nearest hospital and survival from RAAAs in West Sussex.


METHODS
Information was collected regarding outcome, postcode, age, sex and diagnoses for all West Sussex residents who had a RAAA between January 1996 and September 1999, including admissions and deaths, wherever they occurred. Deprivation scores were calculated based on postcode. Potential travel time to the nearest hospital was calculated using "Microsoft AutoRoute Express" and its effect on outcome was analysed using multiple logistic regression.


RESULTS
After adjusting for age, sex, Townsend deprivation score and nearest hospital, the odds ratio for survival associated with a 10 min increase in potential travel time to the nearest hospital was 0.97 (0.88 unadjusted) (95 percent confidence interval for adjusted odds ratio: 0.70 to 1.34; p = 0.86).


CONCLUSIONS
Several previous studies suggested better survival with longer distances travelled. They are likely to be biased by omission of community deaths. This methodologically better study found no such relationship between RAAA survival and travelling time to hospital in West Sussex, although confidence intervals were wide. This is particularly pertinent while there is a push to centralize vascular and other services in the United Kingdom.
Souza
Veena C de
VC
Department of Public Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. vennaandjustin@hotmail.com
Strachan
David P
DP
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000401:mortality*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality*; D015982:Bias; D016001:Confidence Intervals; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000706:statistics & numerical data / Q000600:supply & distribution*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015201:Meta-Analysis as Topic; D012040:Regional Health Planning; D012422:Rupture, Spontaneous; D013043:Specialties, Surgical / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*; D016019:Survival Analysis; D013995:Time; D013997:Time Factors; D014195:Travel