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. 1. Introduction Invasive cardiac revascularization procedures, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG), can improve the outcome of coronary heart disease [1–4]. In a metropolitan urban setting, residency may influence utilization. Inequitable geographic distributions of health care professionals, hospitals, and services provided by these hospitals exist throughout the USA [5]. In New York City (NYC), for example, only few hospitals are licensed to perform cardiac revascularization and they are not uniformly distributed. It has been reported that in some neighborhoods in NYC, due to the unavailability of hospitals performing revascularization in the neighborhood, patients with acute myocardial infarction (AMI) were less likely to undergo revascularization than those living in neighborhoods with hospitals performing revascularization [6]. Nonetheless, whether this is generally the case throughout NYC and what aspect of residency impacts the odds of getting revascularization the most, above and beyond key patient characteristics, is unknown. In this paper, we report on how aspects of residency influence revascularization among AMI patients in NYC by integrating patient-level as well as neighborhood-level data. 2. Methods 2.1. Data Sources We used the 1998–2002 Statewide Planning and Research Cooperative System (SPARCS) database, created and maintained by the New York State Department of Health [7]. The SPARCS
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