Temporal Changes in Geographic Disparities in Access to Emergency Heart Attack and Stroke Care: Are We Any Better Today?

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Spatial and Spatio-temporal Epidemiology

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The objective of this study was to investigate temporal changes in geographic access to emergency heart attack and stroke care. Network analysis was used to compute travel time to the nearest emergency room (ER), cardiac, and stroke centers in Middle Tennessee. Populations within 30, 60, and 90 min driving time to the nearest ER, cardiac and stroke centers were identified. There were improvements in timely access to cardiac and stroke centers over the study period (1999–2010). There were significant (p < 0.0001) increases in the proportion of the population with access to cardiac centers within 30 min from 29.4% (1999) to 62.4% (2009) while that for stroke changed from 5.4% (2004) to 46.1% (2010). Most (96%) of the population had access to an ER within 30 min from 1999 to 2010. Access to care has improved in the last decade but more still needs to be done to address disparities in rural communities.


► Temporal changes in timely access to heart attack and stroke care are investigated. ► Timeliness of access to cardiac and stroke care improved from 1999 to 2010. ► Ninety six percent of the population had access to an ER within 30 min in both 1999 and 2010. ► Neighborhoods with poor access had the lowest median income and housing values. ► Areas with access within 30 min had lower mortality risks than those within 60 min.

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