Geographic access to interventional cardiology services in one rural state

Abstract

Objectives: Explore (1) the characteristics of the Maine population with delayed geographic access to interventional cardiology (IC) services and (2) the effect of delayed geographic IC access on coronary mortality.

Background: Acute coronary syndrome (ACS), ST-segment elevated myocardial infarction (STEMI), and non-ST segment elevated myocardial infarction (NSTEMI) are highly prevalent. Coronary mortality is minimized when victims have prompt IC access.

Methods: The study design was (1) an exploration of census data to investigate disparities in geographic IC access and (2) a secondary analysis of administrative claims data to investigate coronary mortality relative to delayed geographic IC access.

Results: Delayed access was associated in the Maine population with rural residence, advanced age, high school education, and lack of health insurance. Delayed access was associated with increased unadjusted coronary mortality, but not age-adjusted coronary mortality.

Conclusion: Delayed geographic IC access was associated with disparity but not with increased age-adjusted coronary mortality.

Keywords: Access to health care; Acute coronary syndrome; Geographic information system; Mortality; ST-Segment elevated myocardial infarction.