PhD Candidate University of Toronto Toronto, Ontario, Canada
Background: Canada is the second-largest country, but has one of the lowest population densities in the world. Cardiac surgery, while covered under universal health coverage, is regionalized, imposing geographical barriers in large provinces, such as Ontario. This study aimed to determine what proportion of the population across Ontario can reach cardiac surgical care within given distances and time frames, as well as how travel conditions and expanded infrastructure may affect geospatial access.
METHODS AND RESULTS: The Ontario GeoHub, CensusMapper, Ontario Ministry of National Resource and Forestry, Canadian Institute for Health Information, and Statistics Canada were sourced to obtain geospatial datasets on the most recent population densities, dissemination areas boundaries, road infrastructure and regulations, and airport locations. Travel times and distances were calculated by road and air using a least-cost path algorithm for the entire population across Ontario to the nearest cardiac surgical centre using ArcGIS (Esri, Redlands, CA, USA). Sensitivity analyses were performed to consider health systems interventions, such as the establishment of new centres and improved air transfer capacity, as well as evaluate the effects of traffic, off-road access, road closures, and weather conditions. In 2021, 14,223,942 people lived across Ontario, representing, on average, 13.2 people per km2 (range: 1.0/km2 in Northern Ontario - 118.0/km2 in Southern Ontario). A total of 11 cardiac surgical centres were identified across Ontario, equaling one centre per 1.29 million people. Based on travel distance, 74.8% (N=10,642,087), 87.9% (N=12,507,938), and 97.1% (N=13,812,881) of people in Ontario can access a centre within 50km, 100km, or 200km, respectively, with a total range of 0-1,753km (Figure 1). Based on time, 81.9% (N=11,655,837) and 91.8% (N=13,063,517) of people in Ontario can access a centre within one hour or two hours, respectively, with a total range of 0-20.5 hours (Figure 2). The establishment of a new centre at Thunder Bay Regional Health Sciences Centre will improve distance- (additional 0.8-0.9% of the population) and time-based access (additional 0.9-1.0% of the population). Time-based access is highly sensitive to excessive traffic, road closures, and weather conditions (reductions of up to 3.1-10.6% of the population).
Conclusion: In Ontario, geospatial access to cardiac surgery is high for populations in or near metropolitan areas in Southern Ontario but greatly varies for Northern Ontario. The establishment of a new cardiovascular centre in Northwestern Ontario will reduce geospatial barriers, whereas delays imposed by weather and road conditions remain considerable across the province.
