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Abstract
Objective Switzerland has mountains and valleys complicating the access to a hospital and critical care in case of emergencies. Treatment success for acute myocardial infarction (AMI) or stroke depends on timely treatment. We examined the relationship between distance to different hospital types and mortality from AMI or stroke in the Swiss National Cohort (SNC) Study.
Design and setting The SNC is a longitudinal mortality study of the census 2000 population of Switzerland. For 4.5 million Swiss residents not living in a nursing home and older than 30 years in the year 2000, we calculated driving time and straight-line distance from their home to the nearest acute, acute with emergency room, central and university hospital (in total 173 hospitals). On the basis of quintiles, we used multivariable Cox proportional hazard models to estimate HRs of AMI and stroke mortality for driving time distance groups compared to the closest distance group.
Results Over 8 years, 19 301 AMI and 21 931 stroke deaths occurred. Mean driving time to the nearest acute hospital was 6.5 min (29.7 min to a university hospital). For AMI mortality, driving time to a university hospital showed the strongest association among the four types of hospitals with a hazard ratio (HR) of 1.19 (95% CI 1.10 to 1.30) and 1.10 (95% CI 1.01 to 1.20) for men and women aged 65+ years when comparing the highest quintile with the lowest quintile of driving time. For stroke mortality, the association with university hospital driving time was less pronounced than for AMI mortality and did not show a clear incremental pattern with increasing driving time. There was no association with driving time to the nearest hospital.
Conclusions The increasing AMI mortality with increasing driving time to the nearest university hospital but not to any nearest hospital reflects a complex interplay of many factors along the care pathway.
- Distance to hospital
- acute myocardial infarction
- mortality
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors CB conducted the data processing, the analyses and wrote the first draft of the paper. MZ developed the study design and supervised the statistical analyses. RH provided information regarding the interpretation of the results from the emergency medicine perspective and RP helped conduct the analyses using GIS. All authors critically revised the first draft and approved the final manuscript submitted for publication. The authors thank Christopher Ritter for his editorial assistance.
Funding This work was supported by the Swiss National Science Foundation (grant numbers to be found on http://p3.snf.ch: 138056, 108806, 134273 and 148415).
Competing interests None declared.
Ethics approval Approval for the Swiss National Cohort study was obtained from the Ethics Committees of the Cantons of Zurich and Bern and a data centre was established at ISPM Bern. For this type of study, formal consent is not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Individual data from different data sets were used for the construction of the SNC. All these data are the property of the Swiss Federal Statistical Office (SFSO) and can only be made available by legal agreements with the SFSO. This also applies to derivatives such as the analysis files used for this study. However, after approval of the SNC Scientific Board, a specific SNC module contract with SFSO would allow researchers to receive analysis files for replication of the analysis. Data requests should be sent to Professor Milo Puhan (chairman of the SNC Scientific Board, miloalan.puhan@uzh.ch).