Reducing geographic inequalities in access times for acute treatment of myocardial infarction in a large country: the example of Russia

Timonin, Sergey; Kontsevaya, A. V.; McKee, Martin; Leon, David A.

doi:10.1093/ije/dyy146

Cited by 16 publications

(23 citation statements)

References 14 publications

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“…An explanation for the observed variations between and within countries could be the geographic accessibility to a PCI centre. For example, in the USA, where the shortest EMS delays have been observed, it was estimated that about 80% of the population lived within 60 min of a PCI facility in 2000,19 whereas similar estimates were found to be lower in Russia (50%, in 2015),20 Canada (64%, in 2006)21 and Australia (68%, in 2006) 22. Introducing new PCI centres in underserved regions may help to improve accessibility and reduce transport time 23…”

Section: Discussionmentioning

confidence: 98%

Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis

Alrawashdeh

Nehme

Williams

2019

Heart

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ObjectivesTo evaluate emergency medical services (EMS) delays and their impact on time to treatment and mortality in patients with ST-elevation myocardial infarction (STEMI).MethodWe collected data on EMS time intervals from published studies across five electronic databases. The primary EMS interval was the time in minutes between first medical contact and arrival at hospital door (FMC-to-door time). Secondary intervals were other components of EMS delay. Weighted means were measured using random-effects models. Meta-regression was used to identify factors associated with EMS delays and to assess the impact of EMS delay on the proportion of patients treated within90 min and mortality.ResultsTwo independent reviewers included 100 studies (125 343 patients) conducted in 20 countries. The weighted mean FMC-to-door time was 41 min (n=101 646; 95% CI 39 to 43, range 21–88). However, substantial heterogeneity was observed with each interval, which could be explained by region and urban classification, distance to hospital and method of ECG interpretation. In a meta-regression adjusted for door-to-balloon time, a 10 min increase in FMC-to-door time was associated with a 10.6% (95% CI 7.6% to 13.5%; p<0.001) reduction in the proportion of patients treated within 90 min. Shorter EMS delay was significantly associated with lower short-term mortality in patients receiving prehospital thrombolysis (p=0.018).ConclusionEMS delays account for half of the total system delay in STEMI. There is a fourfold global variation in EMS delays, which are not completely explained by differences in system characteristics. Reducing unexplained variation could yield improvements in the time to treatment and outcome of STEMI patients.PROSPERO registration numberCRD42017074118.

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Section: Discussionmentioning

confidence: 98%

Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis

Alrawashdeh

Nehme

Williams

2019

Heart

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“…When explaining the higher level of life expectancy at birth in cities with a population of over 1 million, one should not ignore access to health care, especially involving modern medical technologies, which, due to population density and logistics (infrastructure), is significantly greater in the major agglomerations than in the areas outside them. As an example, if in million-plus cities the whole population lives within a one-hour ride from a PCI 9 center, then for Russia as a whole this figure is only 45% [Timonin et al 2018]. It seems that geographical inequality in the level of accessibility of modern medicine is precisely what is most easily affected by government actors, while other (structural) factors, such as differences in the level of economic development or educational structure, as well as the central-peripheral direction of migration flows, are much harder to change, and their influence can hardly be completely eliminated.…”

Section: Figure 6 Relationship Between Life Expectancy At Birth and mentioning

confidence: 99%

Cities of over a million people on the mortality map of Russia

Aleksei

2019

ДО

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The problem of excess mortality in Russia has not lost its relevance. The situation is complicated by the high level of spatial inequality in health, which is usually measured at the regional level in our country. This work is one of the first attempts to look at the dynamics and extent of spatial inequality in health in Russia at the sub-regional level, by contrasting the "center/core" (in our case, represented by the largest Russian cities) with the "periphery" (the rest of the country). Cities with a population of over a million people were chosen based on the spatial hierarchy that exists in Russia, according to which the highest level of social and economic development is concentrated in the largest cities. As a rule, a higher level of development of human capital corresponds to lower mortality. Using data provided by Rosstat, we calculated life expectancy at birth for Russian cities with a population of over a million people in 1989-2016. The results fully coincided with our expectations: the polarization in the health levels between the largest Russian cities and the rest of the country has significantly increased in the last twenty-five years, which is a reflection of those centripetal processes that have been taking place in our country during this period. Russian cities with a population of over a million people are attractive destinations for both internal and external migrants, and thus acquire, among other things, a much more educated population. Since people with higher education take better care of their health, having a more educated population is undoubtedly an essential advantage of bigger cities over the periphery when it comes to the overall health level. Without solving the structural problems that restrain social and economic development outside the largest agglomerations, convergence in mortality rates between cities with a population of over a million people and the surrounding territories is hardly possible.

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“…Regarding cardiovascular diseases, inequalities in rural patients have been reported with respect to access to treatment, such as percutaneous coronary interventions, which require a longer travelling distance 30 .…”

Section: Mortalitymentioning

confidence: 99%

Effect of the Place of Living on Mortality in Patients with Advanced Heart Failure

Muñoz

García

Navas

et al. 2020

Preprint

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BackgroundSocial and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.MethodsPopulation-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least one year after reaching New York Heart Association IV, between 2010 and 2014.Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality.ResultsMean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged >74 years (p=0.036), and presented lower comorbidity. Mortality percentages were 59% and 51% among rural and urban patients, respectively (p=0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend <0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.ConclusionsLiving in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

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Reducing geographic inequalities in access times for acute treatment of myocardial infarction in a large country: the example of Russia

Cited by 16 publications

References 14 publications

Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis

Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis

Cities of over a million people on the mortality map of Russia

Effect of the Place of Living on Mortality in Patients with Advanced Heart Failure

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