Impact Of Ambulance Diversion: Black Patients With Acute Myocardial Infarction Had Higher Mortality Than Whites

Health Aff (Millwood). 2017 Jun 1;36(6):1070-1077. doi: 10.1377/hlthaff.2016.0925.


This study investigated whether emergency department crowding affects blacks more than their white counterparts and the mechanisms behind which this might occur. Using a nonpublic database of patients in California with acute myocardial infarction between 2001 and 2011 and hospital-level data on ambulance diversion, we found that hospitals treating a high share of black patients with acute myocardial infarction were more likely to experience diversion and that black patients fared worse compared to white patients experiencing the same level of emergency department crowding as measured by ambulance diversion. The ninety-day and one-year mortality rates among blacks exposed to high diversion levels were 2.88 and 3.09 percentage points higher, respectively, relative to whites, representing a relative increase of 19 percent and 14 percent for ninety-day and one-year death, respectively. Interventions that decrease the need for diversion in hospitals serving a high volume of blacks could reduce these disparities.

Keywords: Acute Myocardial Infarction; Disparities; Emergency Department; Mortality.

MeSH terms

  • African Americans / statistics & numerical data*
  • Ambulance Diversion / statistics & numerical data*
  • California
  • Emergency Service, Hospital / statistics & numerical data
  • European Continental Ancestry Group / statistics & numerical data*
  • Hospitals
  • Humans
  • Medicare
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Time Factors
  • United States