Inequities in ambulance allocation associated with transfer delay and mortality in acute coronary syndrome patients: evidence from 89 emergency medical stations in China

International Journal for Equity in Health

Research

Zhi-Jie Zheng¹  Junxiong Ma¹  Shuduo Zhou¹  Yinzi Jin¹  Xuejie Dong¹  Na Li¹  Mailikezhati Maimaitiming¹  Dongmei Li²  Hongjuan Zhang²  Qiang Zhou²  Siwen Li³ 

[1] Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, 100191, Beijing, China;Institute for Global Health and Development, Peking University, Beijing, China;Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, 518025, Shenzhen, China;Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, 518025, Shenzhen, China;Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, 100191, Beijing, China;Institute for Global Health and Development, Peking University, Beijing, China;

关键词: Health resource;    Ambulance inequality;    Acute coronary syndrome;    Prehospital care;    Emergency medical service;   

DOI  :  10.1186/s12939-022-01777-3

 received in 2022-04-11, accepted in 2022-10-16,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAllocation of healthcare resources has a great influence on treatment and outcome of patients. This study aimed to access the inequality of ambulance allocation across regions, and estimate the associations between ambulance density and pre-hospital transfer time and mortality of acute coronary syndromes (ACS) patients.MethodsThis cross-sectional study was based on an integrated database of electronic medical system for 3588 ACS patients from 31 hospitals, ambulance information of 89 emergency medical stations, and public geographical information of 8 districts in Shenzhen, China. The primary outcomes were the associations between ambulance allocation and transfer delay and in-hospital mortality of ACS patients. The Theil index and Gini coefficient were used to assess the fairness and inequality degree of ambulance allocation. Logistic regression was used to model the associations.ResultsThere was a significant inequality in ambulance allocation in Shenzhen (Theil index: 0.59), and the inequality of inter-districts (Theil index: 0.38) was greater than that of intra-districts (Theil index: 0.21). The gap degree of transfer delay, ambulance allocation, and mortality across districts resulted in a Gini coefficient of 0.35, 0.53, 0.65, respectively. Ambulance density was negatively associated with pre-hospital transfer time (OR = 0.79, 95%CI: 0.64,0.97, P = 0.026), with in-hospital mortality (OR = 0.31, 95%CI:0.14,0.70, P = 0.005). The ORs of Theil index in transfer time and in-hospital mortality were 1.09 (95%CI:1.01,1.10, P < 0.001) and 1.80 (95%CI:1.15,3.15, P = 0.009), respectively.ConclusionsRegional inequities existed in ambulance allocation and has a significant impact on pre-hospital transfer delay and in-hospital mortality of ACS patients. It was suggested to increase the ambulance accessibility and conduct health education for public.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 1