Prevention & lipidsResearch article
County-Level Geographic Access and Cardiovascular Disease Outcomes in Washington State
- county-level ecological analysis using multivariable linear regression
- publicly available data and the Google Maps API
- CDC Atlas of Heart Disease and Stroke (2019-2021)
Authors' conclusion
Greater travel burden to specialized cardiac care was associated with higher CVD prevalence and lower hospitalization but not mortality. Socioeconomic factors most strongly predicted CVD mortality, suggesting that reducing geographic disparities requires addressing both care access and socioeconomic determinants.
Study context
- Population
- All Washington state counties
- Participants
- 39 counties
- Comparison
- associations between county-level accessibility metrics and cardiovascular disease (CVD) outcomes
Main finding
As reported in the abstract
Shorter travel time and distance to catheterization laboratories, coronary intervention, and cardiac surgery facilities associated with higher hospitalization rates
R2 = 0.34-0.50
Further findings
Prevalence of coronary heart disease, hypertension, and stroke
- Greater rurality and longer travel burden associated with higher prevalence
- R2 = 0.35-0.56
- all adjusted P < 0.05
Overall heart disease prevalence
- No county-level predictor was associated with overall heart disease prevalence
Ischemic stroke mortality
- Higher area deprivation index and lower median household income the only significant predictors, each associated with higher ischemic stroke mortality
- R2 = 0.41-0.43
- both adjusted P < 0.01
Travel burden in multivariable analyses
- Travel burden remained independently associated with hospitalization but not with prevalence or mortality
- after adjustment for area deprivation, rurality, and age structure
Hospitalization rates and CVD prevalence by CAH reliance
- CAH-reliant counties had lower hospitalization rates but higher CVD prevalence compared with non-CAH-reliant counties
- all P < 0.05
Original publication
Summarised from the published abstract; every number is checked against it