Neighborhood Variation in Rate of Revascularization among Acute Myocardial Infarction Patients in New York City

Objective. To identify modifiable neighborhood factors and quantify their effect on the rate of revascularization among acute myocardial infarction (AMI) patients. Method. Using the New York City hospital discharge records during 1998-2002, we employed a hierarchical regression model that integrates patient-level risk factors and neighborhood-level factors to retrospectively examine revascularization patterns among AMI patients. Results. Access to revascularization varied substantially (27%-88%) among neighborhoods. Ready access to a hospital with on-site capacity of revascularization increased the likelihood of receiving the procedure after adjusting for individual-level sociodemographic factors and comorbidity. More than 64% of the variation in rate of revascularization is explained by access to revascularization. Conclusion. Optimizing the AMI patients' delivery system to hospitals with on-site capacity of revascularization might enhance access to needed care thereby help to alleviate the prevailing variation in the rate of revascularization among New York City neighborhoods.