Map Details – Examining Hospital Discharge Rates for Heart Disease in Counties with Low Geographic Accessibility to Hospitals

Impact Statement

These maps show the heart disease hospitalization discharge rates for counties in Texas as compared to the state average, as well as indicates counties that are outside of a 45-minute drive to a hospital or a hospital with a coronary care unit. These maps could be used to help identify areas to target for heart disease prevention activities.

These maps display the county level age-adjusted hospital discharge rates for heart disease for the state of Texas, all ages, for the year 2017. These rates were used to create three classes: “Significantly Lower than Texas Overall” in off white, “No Significant Difference from Texas Overall” in light orange, and “Significantly Higher than Texas Overall” in dark orange. Counties with insufficient data (less than 12 discharges total), were colored in grey. The Texas heart disease hospital discharge rate is 79.7 per 100,000. Counties with significantly lower heart disease hospitalization rates were primarily located in the central and western regions of the state. Counties with significantly higher heart disease hospitalizations rates were primarily located in the eastern region of the state. These maps also demarcate counties where the majority of the population lives outside of a 45-minute drive from a hospital with black hash-crossing. In most counties, the majority of the population is located within a 45-minute drive of a hospital. Only 0.54 percent of the total population of Texas is outside of a 45-minute drive to a hospital. Counties where the majority of the population is outside of a 45-minute drive from a hospital with a coronary care unit were mainly located in the western portion of the state. Only 2.22 percent of the total population of Texas is outside of a 45-minute drive to a hospital.

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These maps allow readers to see, relative to Texas, where there are areas of high hospitalization due to heart disease, and if the population is within a 45-minute drive of a hospital. The majority of the population of Texas is within a 45-minute drive of a hospital, including hospitals with coronary care units. Twenty-eight of Texas’ 254 counties have populations that are outside of a 45-minute drive to a hospital, and only one of those has higher than average hospitalizations for heart disease. Seventy-eight counties have populations where the majority are more than a 45-minute drive to a hospital with a coronary care unit, and 6 of those have higher than average hospitalization rates. Counties with high hospitalization rates, especially those whose populations are not close to a hospital, may be areas to focus further prevention activities.

ArcGIS

Hospitalization data is from the Inpatient Hospital Discharge Public Use Data File, 2017, Center for Health Statistics, Texas Department of State Health Services. Hospital location data was generated by the Communications Office of the Texas Health and Human Services Commission (HHSC), last updated March 25, 2019. Population data were acquired from the American Community Survey’s 2017 Population Estimates.

Age-adjusted heart disease hospitalization discharge rates with 95% Confidence Intervals were calculated using SAS, version 9.4, for each county and the state overall. The 95% Confidence Intervals were used to determine if a county’s discharge rate was statistically significantly different from that of the state overall. A service area analysis was performed in order to determine the area encompassed within a 45-minute drive of a hospital. This analysis was done twice: first with all hospitals, and second with only hospitals listed as having a coronary care unit. Populations were estimated using population weighted centroids calculated to the census tract level. The percent of the population in each county outside of the drive time was then calculated. The total of the Texas population outside of the drive time was also calculated using the population weighted centroids.

Elizabeth Harker, MPH, Chronic Disease Epidemiology Branch, Texas Department of State Health Services

Elizabeth Harker, MPH, Chronic Disease Epidemiology Branch, Texas Department of State Health Services. Accessed from the Centers for Disease Control and Prevention’s Chronic Disease GIS Exchange https://www.cdc.gov/dhdsp/maps/gisx/mapgallery/tx-hospital-discharge.html