title: Changes in emergency department access between 2001 and 2005 among general and vulnerable populations.
abstract: OBJECTIVE
  We analyzed how ease of geographic access to emergency departments (EDs), defined as driving time to the closest ED, changed between 2001 and 2005, and whether access deterioration was more likely to occur in vulnerable communities.
  
  
  METHODS
  We classified communities on the basis of American Hospital Association and Census data into 3 categories according to driving time to the nearest ED: no increase, less than a 10-minute increase, and a 10-minute or more increase. We estimated a multinomial logit model to examine the relative risk ratio (RRR) of various community characteristics.
  
  
  RESULTS
  More than 95% of communities experienced no ED access deterioration. However, 11.4 million people experienced increased driving time to their nearest ED. Low-income communities had a higher risk of facing deteriorating access compared with high-income communities (urban: RRR = 3.67; P < .01; rural: RRR = 1.75; P < .10), and communities with higher shares of Hispanics also had higher risks of facing declines (urban: RRR = 3.41; P < .10; rural: RRR = 2.67; P < .01).
  
  
  CONCLUSIONS
  Deteriorating access to EDs is more likely to occur in communities with economic hardship and high shares of Hispanic populations. The uneven access to critical services warrants increased attention from policymaking bodies.
authors.affiliation: Graduate School of Business and Public Policy, Naval Postgraduate School, Monterey, CA 93943, USA. yshen@nps.edu
authors.forename: Yu-Chu
authors.initials: YC
authors.lastname: Shen
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000639:trends*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D016015:Logistic Models; D008389:Marketing of Health Services; D015999:Multivariate Analysis; D011156:Population Density; D011204:Poverty Areas; D011320:Primary Health Care / Q000639:trends; D019035:Rural Health Services / Q000639:trends; D012959:Socioeconomic Factors; D014195:Travel / Q000639:trends*; D019037:Urban Health Services / Q000639:trends; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data