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Neighborhood Poverty and 9-1-1 Ambulance Response Time

机译：邻里贫困和9-1-1救护车响应时间

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Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. Methods: We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300). After calculating tract-level median ambulance response time (MART), we used ordinary least squares (OLS) regression to estimate a conditional average relationship between neighborhood poverty and MART and quantile regression to condition this relationship on 25th, 50th, and 75th percentiles of MART. We also specified each of these outcomes by five dispatch priorities and by three intervention severities. For each model, we estimated the associated changes in MART per 10 percentage point increase in tract-level poverty while adjusting for emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, most of our tests suggested tract-level poverty was negatively associated with MART. Our baseline OLS model estimates that a 10 percentage point increase in tract-level poverty is associated with almost a 24s decrease in MART (-23.55s, 95% confidence interval [CI] -33.13 to -13.98). Results from our quantile regression models provided further evidence for this association. Second, we did not find evidence that ambulances are relatively late to poorer neighborhoods when specifying MART by dispatch priority. Third, we were also unable to identify a positive association between tract-level poverty and MART when we specified our outcomes by three intervention severities. Across each of our 36 models, tract-level poverty was either not significantly associated with MART or was negatively associated with MART by a magnitude smaller than a full minute per estimated 10 percentage point increase in poverty concentration. Conclusion: Our study challenges the commonly held assumption that ambulances are later to poor neighborhoods. We scrutinize our findings before cautiously considering their relevance for ambulance response time research and for ongoing conversations on the relationship between neighborhood poverty and prehospital care.
机译：背景：较贫穷的社区距离9-1-1救护车相对较晚？建议的研究经常依赖邻里的弱措施（例如，邮政编码），将分析限制为特定救护车遭遇（例如，心脏骤停响应），并且对派遣优先级或干预严重程度的变化很少。方法：我们将EMS救护车联系记录合并在单个加利福尼亚州（N = 87,554）中，来自美国社区调查（n = 300）的道路级数据。在计算道级中位救护车响应时间（MART）后，我们使用普通的最小二乘（OLS）回归来估计邻里贫困和Mart和Smastile回归之间的条件平均关系，以使这种关系在第25,50和第75百分位数。我们还通过五个派遣优先级和三个干预较严重程度指定了这些结果。对于每个模型，我们估计在调整急诊部门，人口密度和人口大小的同时，每10个百分点增加玛特的相关变化。结果：我们的研究制作了三个主要结果。首先，我们的大部分测试都建议道路级贫困与Mart负相关。我们的基线OLS模型估计，传道级贫困的10个百分点增加与Mart的几乎减少（-23.55s，95％置信区间[CI] -33.13至-13.98）相关。我们的分位数回归模型的结果为此协会提供了进一步的证据。其次，我们没有发现证据表明，在通过派遣优先级指定Mart时，救护车的救护车比较较低。第三，当我们在三个干预较严重程度指定我们的结果时，我们也无法确定派对贫困和市场之间的积极协会。在我们的36种型号中的每一个中，散落级贫困要么没有明显与Mart相关的明显相关，或者与Mart的否定程度小于每估计每估计10个百分点的贫困浓度增加。结论：我们的研究挑战了常见的假设，即救护车后期贫困社区。我们在谨慎地考虑他们对救护车响应时间研究的相关性以及对邻里贫困和追溯关怀之间关系的谈话的相关性。

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