Abstract 15936: Missed Opportunities to Save Lives? The Geography of Non-Transported Cardiac Decedents in a Large Metropolitan Area
Background: People who die from heart disease at home before any attempt at transport may represent missed opportunities for life-saving medical intervention. We undertook a GIS-based, statistical point-pattern spatial analysis of heart disease deaths occurring before transport in a large metropolitan area to determine whether there was geographic clustering of non-transported decedents and if so, whether clusters of non-transported decedents differed significantly on hospital travel distances and area socioeconomic status. We adjusted for individual predictors of transport status.
Methods: We obtained transport status from the place of death variable on the death certificate. We geo-coded heart disease decedents to residential street addresses using a rigorous, multistep process with 97% success. Our final study population consisted of 11,485 adults aged 25-74 years who resided in a large metropolitan area in central Florida and died from heart disease during 1998-2002. We conducted a statistical point-pattern analysis to identify geographic clusters of the residential locations of cardiac decedents where there was a statistically significant excess probability of being either transported or not transported prior to death; we controlled for individual-level covariates using logistic regression-derived probability estimates.
Results: The majority of heart disease decedents were married (53.4%), male (66.4%), white (85.6%), and aged 65-74 years at the time of death (54.7%), and a slight majority were transported prior to death (57.7%). After adjustment for individual predictors, 21 geographic clusters of non-transported heart disease decedents were observed. Contrary to our hypothesis, clusters of non-transported decedents were slightly closer to hospitals than clusters of transported decedents. The social environmental characteristics of clusters varied in the expected direction, with lower socioeconomic and household resources in the clusters of non-transported heart disease deaths.
Conclusions: These results suggest that in this large metropolitan area unfavorable household and neighborhood resources played a larger role than distance to hospital with regard to transport status of cardiac decedents.
- © 2011 by American Heart Association, Inc.