Key result
Higher ambulance density linked to ~69% lower in-hospital mortality in ACS patients.
Why the study?
Allocation of healthcare resources influences patient treatment and outcomes, but the inequality of ambulance allocation across regions and its association with pre-hospital transfer time and mortality in ACS patients required assessment.
Does higher ambulance density reduce pre-hospital transfer delay and in-hospital mortality in ACS patients?
Cross-Sectional (n=3,588)
Yes
Does higher ambulance density reduce pre-hospital transfer delay and in-hospital mortality in ACS patients?
Effect estimate: OR 0.31 (95% CI 0.14, 0.70)
Absolute Event Rate: 7.51% vs 10.6%
p-value: p=0.005
Regional inequities in ambulance allocation significantly impact pre-hospital transfer delays and in-hospital mortality for patients with acute coronary syndromes.
Higher ambulance density was associated with lower ACS mortality; hypothesis-generating and requires prospective confirmation before guiding resource allocation.
BACKGROUND: Allocation 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. METHODS: This 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. RESULTS: There 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. CONCLUSIONS: Regional 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.
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Li et al. (2022) conducted a cross-sectional in Acute Coronary Syndrome (n=3,588). High ambulance density vs. Low ambulance density was evaluated on In-hospital mortality (OR 0.31, 95% CI 0.14, 0.70, p=0.005). Higher ambulance density was significantly associated with lower in-hospital mortality (OR 0.31) and reduced pre-hospital transfer delay (OR 0.79) among acute coronary syndrome patients.
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