title: Investigation of disparities in geographic accessibility to emergency stroke and myocardial infarction care in East tennessee using geographic information systems and network analysis.
abstract: OBJECTIVE
  Stroke and myocardial infarction (MI) require timely geographic accessibility to emergency care. Historically, studies used straight line distances as measures of geographic accessibility. Recently, travel time has been recognized as a better indicator of accessibility because travel impedances can be considered. This study used finer grained transportation data and network analysis to investigate neighborhood disparities in travel time to emergency stroke and MI care.
  
  
  METHODS
  Travel times to stroke and cardiac centers were computed using network analysis, while considering distance, speed limit, road connectivity, and turn impedances. Neighborhoods within 30, 60, or 90 minutes travel were identified. Travel time by air ambulance was calculated and adjusted for flying speed and some delays.
  
  
  RESULTS
  Approximately 8% and 15% of the study population did not have timely geographic accessibility to emergency stroke and MI care, respectively. Populations with poor access were located in rural areas. The entire study population had timely access by air ambulance.
  
  
  CONCLUSIONS
  This study identified disparities in geographic accessibility to emergency stroke and MI care in East Tennessee. Use of air ambulance or telemedicine could play a vital role in addressing these disparities. This information is important for evidence-based health planning and resource allocation.
authors.affiliation: University of Tennessee, Department of Comparative Medicine, Knoxville, TN 37996-4543, USA
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Pedigo
authors.forename: Agricola
authors.initials: A
authors.lastname: Odoi
mesh_terms: D000465:Algorithms; D002391:Catchment Area, Health; D019352:Censuses; D040362:Geographic Information Systems; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D012111:Residence Characteristics; D019035:Rural Health Services; D020521:Stroke / Q000628:therapy; D013714:Tennessee; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods / Q000706:statistics & numerical data*