ArticleCJC open2026
Effect of Community Size and Commute Time on Severity of Pulmonary Arterial Hypertension at Diagnosis and Follow-up in Patients Across 3 Sites.
Article in CJC open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
11 authors.
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Abstract
Background: Rare diseases such as pulmonary arterial hypertension (PAH) require centralized referral centres for diagnosis and management. It is unclear whether a patient's geographic proximity to a referral centre influences the severity of illness on diagnosis and follow-up. Methods: We identified all patients with a diagnosis of PAH across 3 tertiary referral centres. Postal code data were used to stratify patients based on community size. Commute time to a tertiary centre was determined using mapping software. Community size and commute time were compared with baseline catheterization data in addition to follow-up data including biomarkers, functional class, 6-minute walk distance, echocardiography, and repeat catheterization, if available. Follow-up data were used to create a risk factor stratification score as per the most recent guidelines of the European Society of Cardiology/European Respiratory Society. Results: Of the 504 patients in our analysis, 51 (10.1%) lived in a rural area, 69 (13.7%) in a small population centre, 60 (11.9%) in a medium population centre, and 324 (64.3%) in a large urban centre. For commute time, 308 (61.1%) patients had a commute time < 1 hour, 93 (18.5%) patients commuted 1-3 hours, and 103 (20.4%) of patients commuted > 3 hours. There were no robust or consistent associations found between community size or commute time and baseline right heart catheterization data or follow-up indices. Conclusions: In this multicentre analysis we found no clear associations between community size or commute time with severity of illness at diagnosis or follow-up. This supports previous conclusions that patients living in rural communities do not experience disparities in their PAH outcomes.
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