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. 2020 Dec;7(4):302-309.
doi: 10.15441/ceem.19.083. Epub 2020 Dec 31.

The individual and neighborhood factors associated with the use of emergency medical services in patients with ST-elevation myocardial infarction

Hanzo Choi  1 , Won Chul Cha  1 , Ik Joon Jo  1 , Jin-Ho Choi  1 , Min Seob Sim  1 , Taegun Shin  1
Affiliations

The individual and neighborhood factors associated with the use of emergency medical services in patients with ST-elevation myocardial infarction

Hanzo Choi et al. Clin Exp Emerg Med. 2020 Dec.

Abstract

Objective: The utilization of emergency medical services (EMS) varies widely among communities. In this study, we aimed to evaluate the relationship between the use of EMS by patients with ST-elevation myocardial infarction (STEMI) and the individual and neighborhood characteristics of these patients.

Methods: We performed a secondary analysis of data from the Cardiovascular Disease Surveillance project, which included patients diagnosed with STEMI at 29 emergency centers in South Korea. Our analysis included only patients living in Seoul, and the primary outcome measured was the use of EMS. While the clinical variables of the patients were collected from the Cardiovascular Disease Surveillance registry, the 2010 National Census data was used to identify neighborhood variables such as population density, income, age, and residence type. We used a 3-level hierarchical logistic regression to estimate the effects of neighborhood-level factors on EMS use by individual patients.

Results: We evaluated 1,634 patients with STEMI from 2007 to 2012. The neighborhoods were grouped into 25 counties. The regional rates of EMS use varied from 18.3% to 46.5%. The final adjusted logistic model revealed that the use of EMS was significantly associated with the average number of households (neighborhood level factor) and symptoms of syncope, cardiac arrest, and history of cardiovascular disease (individual level factors).

Conclusion: The individual levels factors had a greater influence on the use of EMS compared to the neighborhood-level factors.

Keywords: Acute coronary syndrome; Censuses; Emergency medical services; Logistic models; Residence characteristics.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Flow chart of enrolled ST- patients. STEMI, ST-elevation myocardial infarction; CAVAS, Cardiovascular Disease Surveillance; EMS, emergency medical services.
Fig. 2.
Fig. 2.
Percentage of emergency medical services use in Seoul. Seoul has 25 counties, each called “gu”. Blue points indicate senior general hospitals.
See this image and copyright information in PMC

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