Percutaneous Coronary Intervention in the United States: Risk Factors for Untimely Access

Abstract

Objective: To determine how access to percutaneous coronary intervention (PCI) is distributed across demographics.

Data sources: Secondary data from the 2011 American Hospital Association (AHA) survey data combined with 2010 Census.

Study design: We calculated prehospital times from 32,370 ZIP codes to the nearest PCI center. We used a multivariate logit model to determine the odds of untimely access by the ZIP code's concentration of vulnerable populations.

Data collection: We used ZIP code-level data on community characteristics from the 2010 Census and supplemented it with 2011 AHA survey data on service-line availability of PCI for responding hospitals.

Principal findings: For approximately 306 million Americans, the median prehospital time to the nearest PCI center is 33 minutes. While 84 percent of Americans live within one hour of a PCI center, the odds of untimely access are higher in low-income (OR: 3.00; 95 percent CI: 2.39, 3.77), rural (8.10; 95 percent CI: 6.84, 9.59), and highly Hispanic communities (2.55; 95 percent CI: 1.86, 3.49).

Conclusions: While the majority of Americans live within 60 minutes of a PCI center, rural, low-income, and highly Hispanic communities have worse PCI access. This may translate into worse outcomes for patients with acute myocardial infarction.

Keywords: Myocardial infarction; disparities.

Figure 1

Median Prehospital Time (in Minutes) to Nearest Emergency Department for Urban and Rural Communities, Overall and by Census Division

1. Note. Central lines represent the median prehospital times, and the encompassing boxes represent the interquartile range. The whiskers represent the 5th and 95th percentiles.