Related Experiment Video
Updated: Aug 5, 2026
Assessment of Cardiac Morphological and Functional Changes in Mouse Model of Transverse Aortic Constriction by Echocardiographic Imaging
Published on: June 21, 2016
County-Level Geographic Access and Cardiovascular Disease Outcomes in Washington State
Vladislav Baglaev1, Hovan Dermendjian1, Serj Dermendjian1
1University of Washington, Seattle, Washington, USA.
Insights
Geographic access to cardiac care impacts cardiovascular disease (CVD) prevalence and hospitalization, but not mortality. Addressing socioeconomic factors alongside care access is crucial for reducing disparities.
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.
Background:
Geographic access to specialized cardiac care varies widely, yet how these disparities relate to population-level cardiovascular disease (CVD) outcomes remains poorly understood.
Objectives:
The objective of the study was to evaluate county-level disparities in geographic access to specialized cardiac care and their associations with CVD prevalence, hospitalization, and mortality across Washington state.
Methods:
We assessed county-level variation in average travel time and distance to facilities offering catheterization laboratory, coronary intervention, cardiac surgery, and emergency services across all 39 Washington state counties using publicly available data and the Google Maps API. Reliance on critical access hospitals (CAHs) was also evaluated. Age-adjusted CVD prevalence, mortality, and hospitalization rates were obtained from the CDC Atlas of Heart Disease and Stroke (2019-2021) and multivariable linear regression were used to assess associations between county-level accessibility metrics and CVD outcomes.
Results:
In adjusted univariable analyses, shorter travel time and distance to catheterization laboratories, coronary intervention, and cardiac surgery facilities were associated with higher cardiovascular and heart disease hospitalization rates (R2 = 0.34-0.50, all adjusted P < 0.05). Conversely, greater rurality and longer travel burden to these specialized cardiac services were associated with higher prevalence of coronary heart disease, hypertension, and stroke (R2 = 0.35-0.56; all adjusted P < 0.05). No county-level predictor was associated with overall heart disease prevalence. For mortality, higher area deprivation index and lower median household income were the only significant predictors, each associated with higher ischemic stroke mortality (R2 = 0.41-0.43; both adjusted P < 0.01). 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. CAH-reliant counties had lower hospitalization rates but higher CVD prevalence compared with non-CAH-reliant counties (all P < 0.05).
Conclusions:
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.
Related Concept Videos
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:26Coronary Artery Disease IV: Preventive Measures
01:26Atherosclerosis III: Management
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
01:27Peripheral Artery Disease III: Interprofessional Care
01:21Causality in Epidemiology