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access, cardiovascular disease, geographical information systems, health disparities



  1. Graves, Barbara Ann PhD


Background: Cardiovascular disease is the leading cause of death in the state of Alabama. The purpose of this study was to explore the geographical accessibility of the Alabama population to cardiac interventional services (CISs) for the treatment of acute myocardial infarction.


Methods: A descriptive ecological study design was used. Census tract-level population census data were used to describe access to CIS in Alabama. Descriptive analysis was conducted within a geographical information system (GIS) and provided empirical measures of travel time, calculated population proportions, and generated maps for visual identification of areas of low access. Descriptive statistics are reported as proportions (percentages) of the population with access by travel time.


Findings: The GIS analysis revealed that 58.2%, 85.9%, and 96.0% of the total Alabama population were within 30-, 60-, or 90-minute travel time, respectively, of a hospital with CIS. Maps provided visualization of CIS coverage areas for Alabama. One distinct area within the Alabama Black Belt was at greater than 90 minutes from a hospital with CIS. This area is known as a mostly black, impoverished population subject to health disparities.


Conclusions: The GIS showed that 96% of the Alabama population is within 90-minute travel time of a hospital with CIS. For the best outcomes to occur allowing adequate time for symptom recognition, travel time, and 30-minute door-to-needle time, only 85.9% and 58.2% are within 60- and 30-minute travel time, respectively.