Distance from the nearest hospital and mortality for acute miocardial infarction (AMI) in Sicily Region (Southern Italy)]

OBJECTIVES: to analyse the effect of distance between the Municipality of residence and the nearest hospital on out-of-hospital mortality rate of patients died for acute myocardial infarction (AMI). DESIGN: analysis of out-of-hospital mortality using a record linkage database. SETTING AND PARTICIPANTS: Sicilian Municipalities; 4,999 deaths with acute myocardial infarction as primary cause of death, by excluding patients hospitalised within the 15 days before the death event. MAIN OUTCOME MEASURES: acute myocardial infarction out-of-hospital mortality in Sicilian Municipalities, with the exclusion of patients hospitalised within 15 days before the death event. RESULTS: during the years 2009-2011, 7,473 subjects died for acute myocardial infarction in Sicily. 4,999 (66.92%) patients were not hospitalised in the 15 days before the death event; 2,001 of these (40.01%) lived quite far from the nearest hospital (more than 17 minutes of traveling time). After adjustment for age, gender and socioeconomic status, the distance between the residential Municipality and the nearest hospital was significantly associated with increased mortality (27% higher risk of out-of-hospitalmortality for patients living far from the nearest hospital, compared to those living inmunicipalities with at least one hospital). CONCLUSIONS: the distance between the residential Municipality and the nearest Municipality with at least one hospital is associated with an increase in out-of-hospital mortality rate after acute myocardial infarction. However, besides the limitations of using a distance metric (at a municipality level), the clinical history of the subjects under study is not explicitly taken into account. Further studies are needed in order to explore the reasons for this correlation and to further analyse the relationship between distance and mortality (in-and out-of-hospital). Nevertheless, the results presented provide useful information for healthcare service management policies.