title: Percutaneous Coronary Intervention in the United States: Risk Factors for Untimely Access.
abstract: OBJECTIVE
  To determine how access to percutaneous coronary intervention (PCI) is distributed across demographics.
  
  
  METHODS
  Secondary data from the 2011 American Hospital Association (AHA) survey data combined with 2010 Census.
  
  
  METHODS
  We calculated prehospital times from 32,370 ZIP codes to the nearest PCI center. We used a multivariate logit model to determine the odds of untimely access by the ZIP code's concentration of vulnerable populations.
  
  
  METHODS
  We used ZIP code-level data on community characteristics from the 2010 Census and supplemented it with 2011 AHA survey data on service-line availability of PCI for responding hospitals.
  
  
  RESULTS
  For approximately 306 million Americans, the median prehospital time to the nearest PCI center is 33 minutes. While 84 percent of Americans live within one hour of a PCI center, the odds of untimely access are higher in low-income (OR: 3.00; 95 percent CI: 2.39, 3.77), rural (8.10; 95 percent CI: 6.84, 9.59), and highly Hispanic communities (2.55; 95 percent CI: 1.86, 3.49).
  
  
  CONCLUSIONS
  While the majority of Americans live within 60 minutes of a PCI center, rural, low-income, and highly Hispanic communities have worse PCI access. This may translate into worse outcomes for patients with acute myocardial infarction.
authors.affiliation: Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
authors.affiliation: Naval Postgraduate School, Monterey, CA.|National Bureau of Economic Research, Cambridge, MA.
authors.forename: Yu-Chu
authors.initials: YC
authors.lastname: Shen
mesh_terms: D000367:Age Factors; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D062305:Geographic Mapping; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States
keywords: Myocardial infarction; disparities