| Secondary medical area | |||||
|---|---|---|---|---|---|
| Overall | Urban | Rural | Depopulated | p-value | |
| n = 525,689 | n = 209,843 | n = 266,296 | n = 49,550 | ||
| Age | 77 (68, 84) | 76 (68, 84) | 77 (68, 85) | 79 (70, 86) | <0.0001* |
| Male (%) | 305,126 (58.0) | 123,363 (58.7) | 154,013 (57.8) | 27,750 (56.0) | <0.0001† |
| Comorbidities | |||||
| Hypertension (%) | 275,819 (52.4) | 107,354 (51.1) | 141,819 (53.2) | 26,646 (53.7) | <0.0001† |
| Hyperlipidemia (%) | 160,902 (30.6) | 67,001 (31.9) | 80,937 (30.3) | 12,964 (26.1) | <0.0001† |
| Diabetes mellitus (%) | 134,503 (25.5) | 52,821 (25.1) | 69,761 (26.2) | 11,921 (24.0) | <0.0001† |
| Congestive heart failure (%) | 46,433 (8.8) | 16,842 (8.0) | 24,274 (9.1) | 5,317 (10.7) | <0.0001† |
| Atrial fibrillation (%) | 115,134 (21.9) | 43,523 (20.7) | 59,863 (22.4) | 11,748 (23.7) | <0.0001† |
| Renal disease (%) | 23,781 (4.5) | 9,705 (4.6) | 12,085 (4.5) | 1,991 (4.0) | <0.0001† |
| Obesity (%) | 121,398 (23.0) | 48,451 (23.0) | 61,790 (23.2) | 11,157 (22.5) | 0.0039† |
| Smoking (%) | 159,052 (34.3) | 65,007 (35.6) | 80,131 (33.8) | 13,914 (30.9) | <0.0001† |
| Pre-onset modified Rankin Scale score (%) | |||||
| Grade 0 (%) | 251,009 (47.7) | 102,184 (48.7) | 126,731 (47.5) | 22,094 (44.5) | <0.0001† |
| Grade 1 (%) | 95,399 (18.1) | 37,389 (17.8) | 47,675 (17.9) | 10,335 (20.8) | <0.0001† |
| Grade 2 (%) | 63,611 (12.1) | 25,096 (11.9) | 32,572 (12.2) | 5,943 (11.9) | 0.0126† |
| Grade 3 (%) | 48,068 (9.1) | 19,534 (9.3) | 24,366 (9.1) | 4,168 (8.4) | <0.0001† |
| Grade 4 (%) | 47,521 (9.0) | 18,426 (8.7) | 24,435 (9.1) | 4,660 (9.4) | <0.0001† |
| Grade 5 (%) | 20,081 (3.8) | 7,214 (3.4) | 10,517 (3.9) | 2,350 (4.7) | <0.0001† |
| JCS score upon admission | |||||
| 0 (%) | 252,878 (48.1) | 101,296 (48.2) | 128,616 (48.3) | 22,966 (46.3) | <0.0001† |
| 1-digit code (%) | 201,247 (38.2) | 81,166 (38.6) | 100,583 (37.7) | 19,498 (39.3) | <0.0001† |
| 2-digit code (%) | 47,680 (9.0) | 18,572 (8.8) | 24,510 (9.2) | 4,598 (9.2) | <0.0001† |
| 3-digit code (%) | 23,765 (4.5) | 8,767 (4.1) | 12,516 (4.7) | 2,482 (5.0) | <0.0001† |
| Traits of the admitting hospital | |||||
| Training and educational institution (%) | 435,679 (82.8) | 175,549 (83.6) | 222,147 (83.4) | 37,983 (76.6) | <0.0001† |
| Bed count | 455 (327, 606) | 451 (326, 613) | 482 (340, 609) | 388 (300, 460) | <0.0001* |
| Traits of the residential area | |||||
| ACDI | 1.00 (0.77, 1.22) | 0.99 (0.74, 1.10) | 1.06 (0.84, 1.24) | 0.93 (0.81, 1.24) | <0.0001* |
| Distance from the admitting hospital (km) | 4.12 (2.14, 8.03) | 2.95 (1.66, 5.00) | 5.14 (2.63, 9.62) | 8.71 (3.64, 17.06) | <0.0001* |
| ACDI | ||||||
|---|---|---|---|---|---|---|
| Overall | 1st quartile | 2nd quartile | 3rd quartile | 4th quartile | Trend test | |
| p-value | ||||||
| Urban | ||||||
| ACDI | 1.39-0.59 | 1.39-1.10 | 1.10-0.99 | 0.99-0.74 | 0.74-0.59 | ― |
| Number of patients | 209,843 | 56,444 | 45,133 | 58,004 | 50,262 | ― |
| JCS score upon admission | ||||||
| 0 (%) | 101,296 (48.2) | 27,263 (48.3) | 22,599 (50.0) | 28,456 (49.0) | 22,978 (45.7) | <0.0001* |
| 1-digit code (%) | 81,166 (38.6) | 22,318 (39.5) | 15,824 (35.0) | 22,472 (38.7) | 20,552 (40.9) | <0.0001* |
| 2-digit code (%) | 18,572 (8.8) | 4,518 (8.0) | 4,710 (10.4) | 4,805 (8.2) | 4,539 (9.0) | 0.0134* |
| 3-digit code (%) | 8,767 (4.1) | 2,333 (4.1) | 1,994 (4.4) | 2,263 (3.9) | 2,177 (4.3) | 0.4145* |
| EMS utilization (%) | 128,701 (61.3) | 33,759 (59.8) | 28,079 (62.2) | 36,129 (62.2) | 30,734 (61.1) | <0.0001* |
| Reperfusion therapy (%) | 22,565 (10.7) | 6,456 (11.49) | 4,798 (10.6) | 5,695 (9.8) | 5,616 (11.1) | 0.0008* |
| Rehabilitation (%) | 189,849 (90.4) | 51,667 (91.5) | 40,279 (89.2) | 52,348 (90.2) | 45,555 (90.6) | <0.0001* |
| Admission to training and educational institution (%) | 175,549 (83.6) | 47,244 (83.7) | 37,829 (83.8) | 49,873 (85.9) | 40,603 (80.7) | <0.0001* |
| Bed count | 451 (326, 613) | 424 (279, 615) | 581 (344, 738) | 419 (322, 547) | 500 (350, 610) | <0.0001† |
| In-hospital mortality (%) | 9,840 (4.68) | 2,276 (4.03) | 2,041 (4.52) | 2,811 (4.85) | 2,712 (5.40) | <0.0001* |
| Rural | ||||||
| ACDI | 1.90-0.52 | 1.90-1.24 | 1.24-1.06 | 1.06-0.85 | 0.85-0.52 | ― |
| Number of patients | 266,296 | 66,828 | 66,323 | 66,542 | 66,603 | ― |
| JCS score upon admission | ||||||
| 0 (%) | 128,616 (48.3) | 30,173 (45.1) | 30,304 (45.7) | 33,015 (49.6) | 35,124 (52.7) | <0.0001* |
| 1-digit code (%) | 100,583 (37.7) | 27,587 (41.2) | 26,689 (40.2) | 24,107 (36.2) | 22,200 (33.3) | <0.0001* |
| 2-digit code (%) | 24,510 (9.2) | 6,015 (9.0) | 6,234 (9.4) | 6,281 (9.4) | 5,980 (8.9) | 0.4808 |
| 3-digit code (%) | 12,516 (4.7) | 3,051 (4.5) | 3,069 (4.6) | 3,135 (4.7) | 3,261 (4.9) | 0.0017 |
| EMS utilization (%) | 153,868 (57.7) | 38,327 (57.3) | 38,390 (57.8) | 38,483 (57.8) | 38,668 (58.0) | 0.0078* |
| Reperfusion therapy (%) | 26,295 (9.8) | 6,822 (10.29) | 6,635 (10.0) | 6,664 (10.0) | 6,174 (9.2) | <0.0001* |
| Rehabilitation (%) | 239,508 (89.9) | 60,309 (90.2) | 59,958 (90.4) | 59,777 (89.8) | 59,464 (89.2) | 0.2221* |
| Admission to training and educational institution (%) | 222,147 (83.4) | 58,192 (87.0) | 57,663 (86.9) | 54,276 (81.5) | 52,016 (78.1) | <0.0001* |
| Bed count | 482 (340, 609) | 514 (400, 637) | 440 (320, 605) | 450 (325, 592) | 500 (350, 661) | <0.0001† |
| In-hospital mortality (%) | 14,968 (5.62) | 3,398 (5.08) | 3,653 (5.51) | 3,709 (5.57) | 4,208 (6.32) | <0.0001* |
| Depopulated | ||||||
| ACDI | 1.93-0.18 | 1.93-1.25 | 1.25-0.95 | 0.95-0.82 | 0.82-0.18 | ― |
| Number of patients | 49,550 | 11,549 | 13,010 | 11,794 | 13,197 | ― |
| JCS score upon admission | ||||||
| 0 (%) | 22,966 (46.3) | 5,321 (46.0) | 5,932 (45.6) | 5,878 (49.8) | 5,835 (44.2) | 0.1617 |
| 1-digit code (%) | 19,498 (39.3) | 4,720 (40.8) | 5,058 (38.8) | 4,162 (35.2) | 5,558 (42.1) | 0.2550 |
| 2-digit code (%) | 4,598 (9.2) | 986 (8.5) | 1,325 (10.1) | 1,122 (9.5) | 1,165 (8.8) | 0.4599 |
| 3-digit code (%) | 2,482 (5.0) | 522 (4.5) | 693 (5.3) | 632 (5.3) | 635 (4.8) | 0.2039 |
| EMS utilization (%) | 26,878 (54.2) | 5,833 (50.59) | 6,827 (52.4) | 6,506 (55.1) | 7,712 (58.4) | <0.0001* |
| Reperfusion therapy (%) | 3,902 (7.8) | 837 (7.2) | 945 (7.2) | 966 (8.1) | 1,154 (8.7) | <0.0001* |
| Rehabilitation (%) | 43,425 (87.6) | 9,748 (84.4) | 11,077 (85.1) | 10,675 (90.5) | 11,925 (90.3) | <0.0001* |
| Admission to training and educational institution (%) | 37,983 (76.6) | 9,077 (78.6) | 10,436 (80.2) | 9,899 (83.9) | 8,571 (64.9) | <0.0001* |
| Bed count | 388 (300, 460) | 410 (354, 514) | 355 (304, 445) | 354 (270, 490) | 350 (271, 438) | <0.0001† |
| In-hospital mortality (%) | 3,329 (6.71) | 838 (7.26) | 879 (6.76) | 716 (6.07) | 896 (6.79) | 0.0272* |
| Home-to-hospital distance | ||||||
|---|---|---|---|---|---|---|
| Overall | 1st quartile | 2nd quartile | 3rd quartile | 4th quartile | Trend test | |
| p-value | ||||||
| Urban | ||||||
| Distance (km) | 0-49.95 | 0-1.66 | 1.66-2.95 | 2.95-5.00 | 5.00-49.95 | ― |
| Number of patients | 209,843 | 52,458 | 52,459 | 52,465 | 52,461 | ― |
| JCS score upon admission | ||||||
| 0 (%) | 101,296 (48.2) | 26,297 (50.1) | 25,302 (48.2) | 24,615 (46.9) | 25,082 (47.8) | <0.0001* |
| 1-digit code (%) | 81,166 (38.6) | 19,940 (38.0) | 20,331 (38.7) | 20,738 (39.5) | 20,157 (38.4) | 0.0175* |
| 2-digit code (%) | 18,572 (8.8) | 4,307 (8.2) | 4,668 (8.9) | 4,810 (9.1) | 4,787 (9.1) | <0.0001* |
| 3-digit code (%) | 8,767 (4.1) | 1,906 (3.6) | 2,142 (4.0) | 2,293 (4.3) | 2,426 (4.6) | <0.0001* |
| EMS utilization (%) | 128,701 (61.3) | 29,577 (56.3) | 32,002 (61.0) | 33,135 (63.1) | 33,987 (64.7) | <0.0001* |
| Reperfusion therapy (%) | 22,565 (10.7) | 4,766 (9.0) | 5,407 (10.3) | 5,791 (11.0) | 6,601 (12.5) | <0.0001* |
| Rehabilitation (%) | 189,849 (90.4) | 47,747 (91.0) | 47,674 (90.8) | 47,628 (90.7) | 46,800 (89.2) | <0.0001* |
| Admission to training and educational institution (%) | 175,549 (83.6) | 42,104 (80.2) | 43,459 (82.8) | 44,753 (85.3) | 45,233 (86.2) | <0.0001* |
| Bed count | 451 (326, 613) | 417 (317, 584) | 440 (325, 610) | 469 (329, 613) | 499 (333, 659) | <0.0001† |
| In-hospital mortality (%) | 9,840 (4.68) | 2,400 (4.5) | 2,435 (4.6) | 2,491 (4.7) | 2,514 (4.7) | 0.0333* |
| Rural | ||||||
| Distance (km) | 0-49.99 | 0-2.63 | 2.63-5.14 | 5.14-9.62 | 9.62-49.99 | ― |
| Number of patients | 266,296 | 66,570 | 66,562 | 66,588 | 66,576 | ― |
| JCS score upon admission | ||||||
| 0 (%) | 128,616 (48.3) | 33,308 (50.0) | 33,047 (49.6) | 32,322 (48.5) | 29,939 (44.9) | <0.0001* |
| 1-digit code (%) | 100,583 (37.7) | 24,808 (37.2) | 24,584 (36.9) | 24,763 (37.2) | 26,428 (39.7) | <0.0001* |
| 2-digit code (%) | 24,510 (9.2) | 5,591 (8.4) | 5,910 (8.8) | 6,259 (9.4) | 6,750 (10.1) | <0.0001* |
| 3-digit code (%) | 12,516 (4.7) | 2,841 (4.2) | 3,008 (4.5) | 3,232 (4.8) | 3,435 (5.1) | <0.0001* |
| EMS utilization (%) | 153,868 (57.7) | 34,905 (52.4) | 37,122 (55.7) | 38,979 (58.5) | 42,862 (64.3) | <0.0001* |
| Reperfusion therapy (%) | 26,295 (9.8) | 5,867 (8.8) | 6,146 (9.2) | 6,650 (9.9) | 7,632 (11.4) | <0.0001* |
| Rehabilitation (%) | 239,508 (89.9) | 59,837 (89.8) | 59,973 (90.1) | 59,918 (89.9) | 59,780 (89.7) | 0.2221* |
| Admission to training and educational institution (%) | 222,147 (83.4) | 53,608 (80.5) | 54,707 (82.1) | 56,166 (84.3) | 57,666 (86.6) | <0.0001* |
| Bed count | 482 (340, 609) | 470 (325, 595) | 480 (343, 606) | 489 (340, 630) | 500 (350, 651) | <0.0001† |
| In-hospital mortality (%) | 14,968 (5.62) | 3,573 (5.3) | 3,672 (5.5) | 3,831 (5.7) | 3,892 (5.8) | <0.0001* |
| Depopulated | ||||||
| Distance (km) | 0-49.97 | 0-3.64 | 3.64-8.71 | 8.71-17.06 | 17.06-49.97 | ― |
| Number of patients | 49,550 | 12,387 | 12,387 | 12,377 | 12,399 | ― |
| JCS score upon admission | ||||||
| 0 (%) | 22,966 (46.3) | 6,169 (49.8) | 5,852 (47.2) | 5,723 (46.2) | 5,222 (42.1) | <0.0001* |
| 1-digit code (%) | 19,498 (39.3) | 4,601 (37.1) | 4,896 (39.5) | 4,870 (39.3) | 5,131 (41.3) | <0.0001* |
| 2-digit code (%) | 4,598 (9.2) | 1,016 (8.2) | 1,062 (8.5) | 1,113 (8.9) | 1,407 (11.3) | <0.0001* |
| 3-digit code (%) | 2,482 (5.0) | 600 (4.8) | 574 (4.6) | 670 (5.4) | 638 (5.1) | 0.0273* |
| EMS utilization (%) | 26,878 (54.2) | 5,613 (45.3) | 6,171 (49.8) | 6,883 (55.6) | 8,211 (66.2) | <0.0001* |
| Reperfusion therapy (%) | 3,902 (7.8) | 709 (5.7) | 812 (6.5) | 901 (7.2) | 1,480 (11.9) | <0.0001* |
| Rehabilitation (%) | 43,425 (87.6) | 10,695 (86.3) | 10,833 (87.4) | 10,915 (88.1) | 10,982 (88.5) | <0.0001* |
| Admission to training and educational institution (%) | 37,983 (76.6) | 8,853 (71.4) | 9,639 (77.8) | 9,436 (76.2) | 10,055 (81.1) | <0.0001* |
| Bed count | 388 (300, 460) | 354 (300, 426) | 354 (300, 435) | 379 (304, 456) | 435 (320, 558) | <0.0001† |
| In-hospital mortality (%) | 3,329 (6.71) | 881 (7.1) | 848 (6.8) | 850 (6.8) | 750 (6.0) | 0.0008* |
| Model 1 | Model 2 | Model 3 | |||||||
|---|---|---|---|---|---|---|---|---|---|
| OR | 95% CI | p-value | AOR | 95% CI | p-value | AOR | 95% CI | p-value | |
| Association between ACDI and in-hospital mortality | |||||||||
| Urban | |||||||||
| First quantile | Ref. | Ref. | Ref. | ||||||
| Second quantile | 1.130 | 1.018-1.254 | 0.0223 | 1.160 | 1.046-1.288 | 0.0051 | 1.161 | 1.022-1.318 | 0.0216 |
| Third quantile | 1.103 | 0.998-1.219 | 0.0560 | 1.199 | 1.086-1.324 | 0.0003 | 1.238 | 1.100-1.393 | 0.0004 |
| Fourth quantile | 1.126 | 1.009-1.256 | 0.0332 | 1.277 | 1.147-1.421 | <0.0001 | 1.354 | 1.193-1.538 | <0.0001 |
| Rural | |||||||||
| First quantile | Ref. | Ref. | Ref. | ||||||
| Second quantile | 1.062 | 0.958-1.178 | 0.2548 | 1.081 | 0.978-1.196 | 0.1260 | 1.120 | 0.992-1.264 | 0.0671 |
| Third quantile | 1.120 | 1.016-1.235 | 0.0223 | 1.156 | 1.052-1.271 | 0.0027 | 1.150 | 1.025-1.290 | 0.0172 |
| Fourth quantile | 1.174 | 1.058-1.303 | 0.0026 | 1.293 | 1.169-1.430 | <0.0001 | 1.259 | 1.112-1.425 | 0.0003 |
| Depopulated | |||||||||
| First quantile | Ref. | Ref. | Ref. | ||||||
| Second quantile | 0.843 | 0.695-1.023 | 0.0844 | 0.874 | 0.725-1.054 | 0.1600 | 0.895 | 0.732-1.093 | 0.2761 |
| Third quantile | 0.806 | 0.666-0.976 | 0.0276 | 0.832 | 0.691-1.002 | 0.0520 | 0.952 | 0.779-1.164 | 0.6315 |
| Fourth quantile | 0.899 | 0.750-1.077 | 0.2483 | 0.980 | 0.822-1.169 | 0.8237 | 1.053 | 0.871-1.274 | 0.5925 |
| Association between home-to-hospital distance and in-hospital mortality | |||||||||
| Urban | |||||||||
| First quantile | Ref. | Ref. | Ref. | ||||||
| Second quantile | 1.010 | 0.954-1.073 | 0.689 | 1.018 | 0.960-1.080 | 0.5511 | 0.961 | 0.894-1.032 | 0.2747 |
| Third quantile | 1.040 | 0.981-1.103 | 0.188 | 1.066 | 1.005-1.131 | 0.0350 | 0.961 | 0.894-1.033 | 0.2822 |
| Fourth quantile | 1.080 | 1.020-1.150 | 0.008 | 1.187 | 1.118-1.261 | <0.0001 | 0.964 | 0.895-1.038 | 0.3299 |
| Rural | |||||||||
| First quantile | Ref. | Ref. | Ref. | ||||||
| Second quantile | 1.043 | 0.993-1.094 | 0.0909 | 1.054 | 1.003-1.107 | 0.0358 | 0.999 | 0.942-1.060 | 0.9745 |
| Third quantile | 1.085 | 1.034-1.139 | 0.0010 | 1.101 | 1.048-1.157 | 0.0001 | 0.993 | 0.935-1.054 | 0.8145 |
| Fourth quantile | 1.120 | 1.066-1.178 | <0.0001 | 1.158 | 1.101-1.217 | <0.0001 | 0.959 | 0.902-1.020 | 0.1856 |
| Depopulated | |||||||||
| First quantile | Ref. | Ref. | Ref. | ||||||
| Second quantile | 0.980 | 0.886-1.084 | 0.6961 | 0.944 | 0.853-1.046 | 0.2700 | 0.903 | 0.799-1.021 | 0.1027 |
| Third quantile | 0.980 | 0.885-1.085 | 0.7004 | 0.935 | 0.844-1.037 | 0.2034 | 0.842 | 0.743-0.953 | 0.0064 |
| Fourth quantile | 0.909 | 0.812-1.017 | 0.0949 | 0.927 | 0.828-1.037 | 0.1860 | 0.782 | 0.681-0.898 | 0.0005 |
