County-Level Geographic Access and Cardiovascular Disease Outcomes in Washington State

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Geographic disparities in specialized cardiac care access are significant.
• The relationship between these access disparities and population-level cardiovascular disease (CVD) outcomes is not well understood.

Purpose of the Study:

• To assess county-level geographic access disparities to specialized cardiac care in Washington state.
• To evaluate the association of these disparities with CVD prevalence, hospitalization, and mortality.

Main Methods:

• Utilized Google Maps API to measure travel time and distance to cardiac facilities across 39 Washington counties.
• Analyzed age-adjusted CVD prevalence, hospitalization, and mortality rates from CDC data (2019-2021).
• Employed multivariable linear regression to link accessibility metrics with CVD outcomes, considering factors like critical access hospital reliance.

Main Results:

• Shorter travel times to cardiac facilities correlated with higher hospitalization rates (R² = 0.34-0.50).
• Increased travel burden and rurality were linked to higher prevalence of coronary heart disease, hypertension, and stroke (R² = 0.35-0.56).
• Area deprivation and low income predicted higher ischemic stroke mortality; travel burden independently predicted hospitalization but not prevalence or mortality in multivariable models.

Conclusions:

• Greater travel burden to specialized cardiac care is associated with increased CVD prevalence and decreased hospitalization, but not mortality.
• Socioeconomic factors are key predictors of CVD mortality.
• Reducing geographic disparities necessitates a dual approach addressing both healthcare access and socioeconomic determinants.