Lee Jae Eun, Sung Jung Hye, Ward William B, Fos Peter J, Lee Won Jae, Kim Jae Chang
Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Jackson, Mississippi, USA.
Geospat Health. 2007 May;1(2):243-53. doi: 10.4081/gh.2007.272.
The aim of this study was to estimate the distance Mississippi patients must travel to access hospital-based emergency rooms (ERs) and to determine whether an association exists between geographic distance and ER utilization. To that end, great circle distances between Census Block Group Centroid Points and 89 hospitals with emergency departments were calculated for the State of Mississippi. Data on the socio-demographic characteristics of each block group came from the 2000 US Census data. Logistic regression analyses were conducted to test if there was any association between ER utilization and travel distance. Compared to the national benchmark of 35.7%, more than one in two (56.7%), or 1,612,762 Mississippians visited ERs in 2003 with an estimated 6.1 miles per person annual travel for this purpose. The majority of the target population (54.9%) was found to live within 5 miles of hospitals with ERs. Logistic analyses revealed that block groups associated with less miles traveled to hospitals with ERs had a higher proportion of African Americans, impoverished people, female householders, people with more than 12 years education, people older than 65 years, people with high median house values, and people without employment. Twenty-nine of the 89 hospitals (33%) providing ER care in Mississippi were found to be in areas with above-average ER utilization rates. These hospitals served a smaller geographical area (28% of the total) but had a greater proportion of visitors (57%) and served a higher percentage (37%) of the state population. People in areas served by the less utilized ERs traveled more miles to be cared for (7.1 miles vs 5.4 miles; p<0.0001). Logistic regression analysis revealed that shorter distances were associated with increased use of the ERs, even after controlling for socio-demographic factors. The conclusion is that Mississippi ERs are typically located in block groups with higher percentages of disadvantaged residents and that people in these areas are more likely to utilize ER services. Our data suggest that the geographical distance has an impact on ER utilization, especially by reducing utilization in disadvantaged block group areas. Disadvantaged persons living near ER hospitals (<5 miles) were found to be more likely to utilize the ER services. Geographic distance should therefore be considered when planning state-wide ER programmes for disadvantaged populations.
本研究的目的是估算密西西比州患者前往医院急诊室所需的行程距离，并确定地理距离与急诊室利用率之间是否存在关联。为此，计算了密西西比州人口普查街区组中心点与89家设有急诊科的医院之间的大圆距离。每个街区组的社会人口特征数据来自2000年美国人口普查数据。进行逻辑回归分析以检验急诊室利用率与行程距离之间是否存在任何关联。与全国35.7%的基准相比，2003年超过二分之一（56.7%），即1,612,762名密西西比人前往急诊室，为此目的每人每年估计行程6.1英里。发现大多数目标人群（54.9%）居住在距离设有急诊室的医院5英里范围内。逻辑分析表明，与前往设有急诊室的医院行程较短的街区组相关的人群中，非裔美国人、贫困人口、女性户主、受过12年以上教育的人、65岁以上的人、房屋中位价值较高的人以及无业人员的比例较高。在密西西比州提供急诊护理的89家医院中有29家（33%）位于急诊室利用率高于平均水平的地区。这些医院服务的地理区域较小（占总面积的28%），但就诊者比例较高（57%），服务的州人口比例也较高（37%）。急诊室利用率较低地区的人们前往接受治疗的行程更远（7.1英里对5.4英里；p<0.0001）。逻辑回归分析表明，即使在控制了社会人口因素之后，较短的距离也与急诊室利用率的增加相关。结论是，密西西比州的急诊室通常位于弱势居民比例较高的街区组，这些地区的人们更有可能利用急诊服务。我们的数据表明，地理距离对急诊室利用率有影响，特别是通过降低弱势街区组地区的利用率。发现居住在急诊医院附近（<5英里）的弱势人群更有可能利用急诊服务。因此，在为弱势人群规划全州范围的急诊项目时应考虑地理距离。
