Send to

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

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

Author information

Renee Y. Hsia ( is a professor in the Department of Emergency Medicine and a core faculty member at the Philip R. Lee Institute for Health Policy Studies, both at the University of California, San Francisco.
Nandita Sarkar is a postdoctoral research analyst at the National Bureau of Economic Research in Cambridge, Massachusetts.
Yu-Chu Shen is a professor at the Graduate School of Business and Public Policy, Naval Postgraduate School, in Monterey, California, and a faculty research fellow at the National Bureau of Economic Research.


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.


Acute Myocardial Infarction; Disparities; Emergency Department; Mortality

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center