Enhancing Externalization of Frontal Virtual Sound Sources in Binaural Synthesis via Level and Reflection Adjustment of Non-individualized BRIRs.

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for over 700,000 deaths annually. In Washington state, heart disease accounted for approximately 11,967 deaths (19.1%) in 2022. CVD prevalence and mortality continue to rise, with projections estimating that by 2050, more than 184 million U.S. adults will be living with CVD. The role of environmental, socioeconomic, and behavioral risk factors as predictors of CVD burden is well established., , , However, these factors vary substantially across regions, contributing to persistent disparities in outcomes. Rural communities are particularly vulnerable, and these disparities persist even after accounting for baseline risk factors., , Geographic access to cardiac care, proximity to hospitals with catheterization laboratories, and the travel burden to reach definitive care vary substantially by region and may contribute to these inequities., , , , Less is known about how differences in geospatial proximity and access to care affect observed regional disparities in CVD burden and outcomes. We sought to examine how geographic disparities in access to cardiovascular services influence CVD outcomes across Washington’s 39 counties. We evaluated accessibility using average travel times and distances from county population centers to hospitals with varying levels of cardiovascular capability, as well as workforce availability, hospital bed capacity, and baseline access to care. Three categories of county-level factors were hypothesized a priori to explain variation in CVD outcomes: 1) baseline access to care and preventive health use; 2) spatial proximity and travel burden to cardiovascular services; and 3) cardiovascular health care workforce and infrastructure capacity (). Understanding these relationships is important to inform resource allocation, achieve equitable care delivery, and ultimately reduce regional disparities in CVD burden.