title: Association between accessibility to emergency cardiovascular centers and cardiovascular mortality in Japan.
abstract: OBJECTIVE
  The aim of this study was to examine the association between accessibility to cardiovascular emergency centers and cardiovascular mortality in Japan.
  
  
  METHODS
  A semi-ecological study.
  
  
  METHODS
  Three databases were generated: accessibility to emergency cardiovascular centers, population records and death records.
  
  
  METHODS
  The standardized mortality ratio (SMR) for cardiovascular disease was adjusted by age and sex. Accessibility was represented by transfer time, number of cardiovascular emergency hospitals, and the proportion of habitable areas. Combinations of the three were divided into Categories 1-8 from the worst to the best, and the association with SMR was analyzed.
  
  
  RESULTS
  There were 1998 cardiovascular emergency hospitals. The median of crude mortality was 0.16%. The median SMR of the reference Category 8 (transfer time <30 min and habitable area ≥50% with cardiovascular emergency hospitals) was 0.96, but that of the low accessibility Category 1 (transfer time ≥30 min and habitable area <50% without cardiovascular emergency hospitals) was 1.10. The SMR of accessibility Category 1 : Category 8 was 1.18 (95% confidence interval: 1.14-1.21).
  
  
  CONCLUSIONS
  Decreased accessibility to cardiovascular emergency hospitals was associated with increased SMR. Areas with less accessibility and higher cardiovascular mortality were characterized by geographical variability in Japan.
authors.affiliation: Department of Clinical Trials and Research, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001, Japan Department of Advanced Medical Technology Development, National Cerebral and Cardiovascular Center, 5-8-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kada
authors.affiliation: Department of Neuropsychopharmacology, National institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yonemoto
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-8-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Hospital Deputy, Shizuoka General Hospital, 4-27-1 Kitaando, Aoiku, Shizuoka 420-0805, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonogi
authors.forename: Hironori
authors.initials: H
authors.lastname: Hanada
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hase
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Syunji
authors.initials: S
authors.lastname: Kasaoka
authors.forename: Migaku
authors.initials: M
authors.lastname: Kikuti
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sase
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Ogawa
authors.initials: O
authors.lastname: Hisao
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.forename: Miho
authors.initials: M
authors.lastname: Kanemitsu
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000401:mortality*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D010360:Patient Transfer / Q000458:organization & administration / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: accessibility; cardiovascular mortality; emergency medical system