title: Neighborhood and Acute Myocardial Infarction Mortality as Related to the Driving Time to Percutaneous Coronary Intervention-Capable Hospital.
abstract: BACKGROUND
  Driving time to a percutaneous coronary intervention (PCI)-capable hospital is important in timely treatment of acute myocardial infarction (AMI). Our objective was to determine whether driving time from one's residence to a PCI-capable hospital contributes to AMI deaths. We conducted a cross-sectional study of age- and sex-adjusted mortality in census block groups to evaluate this question.
  
  
  RESULTS
  We studied all (14 027) AMI deaths that occurred during 2008-2012 in Arkansas to assess the relationship between driving time from the population center of a block group (neighborhood) to the nearest PCI-capable hospital. We estimated standardized mortality ratios in block groups that were adjusted for education (population over 25 years of age who did not graduate from high school), poverty (population living below federal poverty level), population density (population per square mile), mobility (population residing at the same address as 1 year ago), black (population that is black), rurality (rural households), geodesic distance, and driving time. The median geodesic distance and driving time were 12.8 miles (interquartile range 3.6-30.1) and 28.3 minutes (interquartile range 9.6-58.7), respectively. Risks in neighborhoods with long driving times (90th percentile) were 26% greater than risks in neighborhoods with short driving times (10th percentile), even after adjusting for education, poverty, population density, rurality, and black race (P<0.0001).
  
  
  CONCLUSIONS
  AMI mortality increases with increasing driving time to the nearest PCI-capable hospital. Improving the healthcare system by reducing time to arrive at a PCI-capable hospital could reduce AMI deaths.
authors.affiliation: Arkansas Department of Health, Little Rock, AR Department of Epidemiology, University of Arkansas for Medicine for Medical Sciences College of Public Health, Little Rock, AR Division of Cardiology, Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR.
authors.forename: Appathurai
authors.initials: A
authors.lastname: Balamurugan
authors.affiliation: Arkansas Department of Health, Little Rock, AR Department of Epidemiology, University of Arkansas for Medicine for Medical Sciences College of Public Health, Little Rock, AR rdelongchamp@uams.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Delongchamp
authors.affiliation: Arkansas Department of Health, Little Rock, AR.
authors.forename: Lucille
authors.initials: L
authors.lastname: Im
authors.affiliation: Arkansas Department of Health, Little Rock, AR Department of Epidemiology, University of Arkansas for Medicine for Medical Sciences College of Public Health, Little Rock, AR.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bates
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR.
authors.forename: Jawahar L
authors.initials: JL
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001131:Arkansas / Q000453:epidemiology; D002391:Catchment Area, Health; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014187:Transportation of Patients; D016896:Treatment Outcome
keywords: census block groups; driving time; health services; mortality/survival; myocardial infarction; percutaneous coronary intervention; risk factors