The association between heart disease mortality and geographic access to hospitals: county level comparisons in Ohio, USA.

Greater distance to health care facilities is associated with poorer health care service utilization, yet little is known about how the 'decay effect' of distance influences the outcome of heart disease that requires frequent medical care. Heart disease has been a leading cause of death in the United States for a last few decades, even with significant improvements in treatment and management. In this study, we examined the association between physical distance to hospitals and heart disease mortality. The geographic information system (GIS) approach was taken to integrate, visualize and analyze data from multiple sources. Hospitals in the state of Ohio were geocoded and zonal statistics were computed to quantify geographical access to hospitals at the level of Ohio's 88 counties. Whereas the results of bivariate analysis showed a significant association between distance to hospitals and heart disease mortality, this relationship was not significant when accounting for socioeconomic and socio-demographic factors. This study demonstrates the usefulness of visualized health data and makes a case for further research on associations between disease outcomes and access to health care services. Copyright 2010 Elsevier Ltd. All rights reserved.