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Geographical accessibility and Kentucky's heart-related hospital services
Authors:Timothy S Hare  Holly R Barcus  
Institution:aInstitute for Regional Analysis and Public Policy, Morehead State University, Morehead, KY 40351, USA;bGeography Department, Macalester College, Saint Paul, MN 55105, USA
Abstract:Cardiovascular diseases (CVDs) are a leading cause of mortality in the US. Rates of mortality vary spatially and demographically, influenced not only by individual patient characteristics but also by levels of accessibility to hospital services and facilities. In 2000, Kentucky ranked third in the nation for heart-related deaths. The purpose of this paper is to assess geographical accessibility and service utilization related to ambulatory care sensitive CVDs in Kentucky. This study utilizes the Kentucky Hospital Discharge Database to evaluate service utilization and the Compressed Mortality File to examine mortality related to CVDs. A spatial statistical comparison of the geographical distribution of service usage and travel time to hospitals assists in assessing the relationship between accessibility and health. Our findings suggest that the distribution of utilization and mortality is geographically variable. People living in rural areas travel further to services; populations residing more than 45 min from health facilities are more likely to be socially and economically marginalized. Spatial clustering of high rates of hospital utilization occurs in areas with lower accessibility.
Keywords:Cardiovascular disease  Kentucky  Spatial analysis  Accessibility  GIS  Health inequalities
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