title: A multilevel analysis of absence of transport to a hospital before premature cardiac death.
abstract: BACKGROUND
  Prompt transportation to a hospital and aggressive medical treatment can often prevent acute cardiac events from becoming fatal. Consequently, lack of transport before death may represent lost opportunities for life-saving interventions. We investigated the effect of individual characteristics (age, sex, race/ethnicity, education, and marital status) and small-area factors (population density and social cohesion) on the probability of premature cardiac decedents dying without transport to a hospital.
  
  
  METHODS
  We analyzed death data for adults aged 25 to 69 years who resided in the Tampa, Florida, metropolitan statistical area and died from an acute cardiac event from 1998 through 2002 (N = 2,570). Geocoding of decedent addresses allowed the use of multilevel (hierarchical) logistic regression models for analysis.
  
  
  RESULTS
  The strongest predictor of dying without transport was being unmarried (odds ratio, 2.13; 95% confidence interval, 1.79-2.52, P < .001). There was no effect of education; however, white race was modestly predictive of dying without transport. Younger decedent age was a strong predictor. Multilevel statistical modeling revealed that less than 1% of the variance in our data was found at the small-area level.
  
  
  CONCLUSIONS
  Results contradicted our hypothesis that small-area characteristics would increase the probability of cardiac patients receiving transport before death. Instead we found that being unmarried, a proxy of living alone and perhaps low social support, was the most important predictor of people who died from a cardiac event dying without transport to a hospital.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa FL 33612, USA. epathak@health.usf.edu
authors.forename: Elizabeth Barnett
authors.initials: EB
authors.lastname: Pathak
authors.forename: Michele L
authors.initials: ML
authors.lastname: Casper
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Tanner
authors.forename: Steven
authors.initials: S
authors.lastname: Reader
authors.forename: Beverly
authors.initials: B
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death / Q000639:trends; D016001:Confidence Intervals; D005260:Female; D005431:Florida / Q000453:epidemiology; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*
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