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Regional variation of nonrural pediatric ambulance transport rates: an ecological study
1Department of Surgery, University of Michigan, Ann Arbor 48109-0303, USA.
Insights
Pediatric transport rates vary significantly between areas, with higher rates in urban settings. These higher rates may correlate with increased mortality and reduced personal transportation access.
Area of Science:
- Pediatric Emergency Medicine
- Public Health Systems
- Health Services Research
Background:
- Pediatric transport rates by Emergency Medical Services (EMS) exhibit considerable variation.
- Socioeconomic factors and mortality rates are potential influencers of these transport disparities.
Purpose of the Study:
- To investigate the relationship between pediatric transport rates and socioeconomic status.
- To explore the correlation between pediatric transport rates and mortality within EMS systems.
Main Methods:
- Retrospective ecological study of four EMS Medical Control Authorities (MCAs) in Michigan.
- Analysis of 3,792 pediatric patients (0-19 years) transported via ambulance.
- Spearman rank correlation used to analyze transport rate (RATE) against income (INCOME), vehicle access (VEHICLE), education (EDUC), physician availability (PHYS), and EMS disease death rate (EMSDD).
Main Results:
- Pediatric transport rates varied widely (325-750 per 100,000 pediatric population) across MCAs.
- The most urban MCA showed a fourfold higher transport rate in the 0-4 age group.
- Transport rates were inversely correlated with INCOME, EDUC, and VEHICLE access (r = -1.00, P < 0.001) and positively correlated with EMSDD (r = 1.00, P < 0.001).
Conclusions:
- Significant variations in pediatric transport rates between MCAs are likely influenced by high rates in urban areas, particularly for young children.
- Higher pediatric EMS utilization may be linked to increased mortality and lack of private transportation.
- Socioeconomic factors play a crucial role in pediatric emergency transport utilization patterns.
Study Objective:
To determine the relationship of pediatric transport rates per hundred thousand pediatric population (RATE) to socioeconomic status (SES) factors and also mortality in Emergency Medical Services (EMS) systems.
Design:
Retrospective ecological study.
Setting:
Four EMS Medical Control Authorities (MCAs) in Michigan.
Participants:
Patients (3,792), 0-19 years of age, responded to as a nonscheduled emergency response and transported to a hospital by ambulance.
Methods And Measurements:
RATE, economic status (INCOME), private transportation status (VEHICLE), educational status (EDUC), primary care physician availability (PHYS), and EMS disease death rate (EMSDD) were determined for each MCA and analyzed using Spearman rank correlation.
Results:
RATE between MCAs varied from 325 to 750. RATE was highest in the most urban MCA: its 0-4 RATE was fourfold larger than any other MCA. INCOME, EDUC, and VEHICLE were inversely correlated with transport rate: -1.00, -1.00, -1.00; P < 0.001. Rate was positively correlated with EMSDD: 1.00; P < 0.001.
Conclusions:
Substantial variation in RATE between MCAs may be primarily due to the high 0-4 transport rate in the most urban MCA. This study also suggests that higher pediatric EMS system utilization rates may be correlated to higher mortality and also to unavailability of personal transportation.