A Multilevel Analysis of Absence of Transport to a Hospital Before Premature Cardiac Death - Preventing Chronic Disease: May 2010: 09_0059

ORIGINAL RESEARCH
A Multilevel Analysis of Absence of Transport to a Hospital Before Premature Cardiac Death

TABLE OF CONTENTS
• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Elizabeth Barnett Pathak, PhD; Michele L. Casper, PhD; Jean Paul Tanner, MPH; Steven Reader, PhD; Beverly Ward, PhD
Suggested citation for this article: Pathak EB, Casper ML, Tanner JP, Reader S, Ward B. A multilevel analysis of absence of transport to a hospital before premature cardiac death. Prev Chronic Dis 2010;7(3). http://www.cdc.gov/pcd/issues/2010/may/09_0059.htm. Accessed [date].

Abstract
Introduction
Prompt transportation to a hospital and aggressive medical treatment can often prevent acute cardiac events from becoming fatal. Consequently, lack of transport before death may represent lost opportunities for life-saving interventions. We investigated the effect of individual characteristics (age, sex, race/ethnicity, education, and marital status) and small-area factors (population density and social cohesion) on the probability of premature cardiac decedents dying without transport to a hospital.

Methods
We analyzed death data for adults aged 25 to 69 years who resided in the Tampa, Florida, metropolitan statistical area and died from an acute cardiac event from 1998 through 2002 (N = 2,570). Geocoding of decedent addresses allowed the use of multilevel (hierarchical) logistic regression models for analysis.

Results
The strongest predictor of dying without transport was being unmarried (odds ratio, 2.13; 95% confidence interval, 1.79-2.52, P < .001). There was no effect of education; however, white race was modestly predictive of dying without transport. Younger decedent age was a strong predictor. Multilevel statistical modeling revealed that less than 1% of the variance in our data was found at the small-area level.

Conclusions
Results contradicted our hypothesis that small-area characteristics would increase the probability of cardiac patients receiving transport before death. Instead we found that being unmarried, a proxy of living alone and perhaps low social support, was the most important predictor of people who died from a cardiac event dying without transport to a hospital.

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Preventing Chronic Disease: May 2010: 09_0059