The lack of access to timely emergency medical services has strong implications for adverse health outcomes, including survival rates after an acute event such as cardiac arrest. Recent analyses by the Maine Rural Health Research Center (MRHRC) of 41 states found over 4 million people were living in ambulance deserts in 2020-2021, defined as residential locations more than a 25-minute drive from where an ambulance station is located. This project will use MRHRC ambulance data along with data from CDC WONDER to assess whether living in an ambulance desert is associated with higher mortality rates among rural and urban populations, defined using Rural Urban Continuum Codes. Data from the American Community Survey, County Health Rankings, and the Area Health Resources Files will provide underlying socioeconomic and market factors that may moderate the effect of living in an ambulance desert on mortality.

Using these linked data, we will conduct:

• A descriptive analysis of the association between the percent of people living in ambulance deserts and mortality rates by geographic location.
• A regression analyses to estimate the relationship between the rate of a county's population living in ambulance deserts on mortality rates.

As samples permit, we will examine specific causes of death such as injury, heart attack, and stroke.