BackgroundDriving time to a percutaneous coronary intervention (PCI)–capable hospital is important in timely treatment of acute myocardial infarction (AMI). Our objective was to determine whether driving time from one's residence to a PCI‐capable hospital contributes to AMI deaths. We conducted a cross‐sectional study of age‐ and sex‐adjusted mortality in census block groups to evaluate this question.Methods and ResultsWe studied all (14 027) AMI deaths that occurred during 2008–2012 in Arkansas to assess the relationship between driving time from the population center of a block group (neighborhood) to the nearest PCI‐capable hospital. We estimated standardized mortality ratios in block groups that were adjusted for education (population over 25 years of age who did not graduate from high school), poverty (population living below federal poverty level), population density (population per square mile), mobility (population residing at the same address as 1 year ago), black (population that is black), rurality (rural households), geodesic distance, and driving time. The median geodesic distance and driving time were 12.8 miles (interquartile range 3.6–30.1) and 28.3 minutes (interquartile range 9.6–58.7), respectively. Risks in neighborhoods with long driving times (90th percentile) were 26% greater than risks in neighborhoods with short driving times (10th percentile), even after adjusting for education, poverty, population density, rurality, and black race (P<0.0001).Conclusions AMI mortality increases with increasing driving time to the nearest PCI‐capable hospital. Improving the healthcare system by reducing time to arrive at a PCI‐capable hospital could reduce AMI deaths.

Objective We examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth. Study design We analyzed data for 6336 pregnant persons with SARS-CoV-2 infection in 2020 in the United States. Risk ratios for preterm birth were calculated for illness severity, trimester of infection, and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications. Result Pregnant persons with critical COVID-19 or asymptomatic infection, compared to mild COVID-19, in the second or third trimester were at increased risk of preterm birth. Pregnant persons with moderate-to-severe COVID-19 did not show increased risk of preterm birth in any trimester. Conclusion Critical COVID-19 in the second or third trimester was associated with increased risk of preterm birth. This finding can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons.

Background: Pregnant persons with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection are at increased risk of preterm birth, and evidence suggests this risk may be higher among pregnant persons with severe coronavirus disease 2019 (COVID-19) or among those infected later in pregnancy. However, the relationship between trimester of SARS-CoV-2 infection, severity of COVID-19, and preterm birth is not fully understood.Objective: This study examined the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth after adjusting for maternal age, selected underlying conditions, and pregnancy complications.Study Design: Using a cohort of 6,396 pregnant persons with SARS-CoV-2 infection in 2020 identified through the Surveillance for Emerging Threats to Mothers and Babies Network, we analyzed data for those with infection at <37 weeks gestation who delivered a singleton liveborn infant. Illness severity groups (asymptomatic infection, mild, moderate-to-severe, and critical) were adapted from National Institutes of Health and World Health Organization criteria. Risk ratios for preterm birth (<37 weeks) were calculated for illness severity categories (referent=mild), trimester of SARS-CoV-2 infection (referent=first trimester), and illness severity stratified by trimester of infection adjusted for age, selected underlying medical conditions, and pregnancy complications.Results: Pregnant persons with critical COVID-19, compared to mild COVID-19, in the second (aRR 3.9; 95% CI: 1.7-9.0) or third (aRR 4.6; 95% CI: 3.2-6.6) trimester were at increased risk of preterm birth. Among persons infected in the second or third trimester, those with critical COVID-19 delivered sooner after infection compared with persons with mild COVID-19 (p<0.001 for second trimester and p=0.02 for third trimester). Nearly half of those with moderate-to-severe or critical COVID-19 delivered by cesarean, with most critical COVID-19 cesarean deliveries as emergent (76.6% weighted [65/96 unweighted]).Conclusion: When infection occurred in the second or third trimester, critical COVID-19 was associated with increased risk of preterm birth, and those with critical COVID-19 delivered sooner after infection compared to those with mild COVID-19. These findings can be used to guide prevention strategies, including vaccination, and inform clinical practices for pregnant persons, particularly those presenting with critical COVID-19 later in pregnancy.