International Journal of Environmental Research and Public Health Article Investigating the Geographic Disparities of Amenable Mortality and Related Ambulance Services in Hungary Máté Sándor Deák 1,2 ,Gábor Csató 3 , György Pápai 3 , Viktor Dombrádi 4 , Attila Nagy 1 , Csilla Nagy 5 , Attila Juhász 5 and Klára Bíró 6, *   Citation: Deák, M.S.; Csató, G.; Pápai, G.; Dombrádi, V.; Nagy, A.; Nagy, C.; Juhász, A.; Bíró, K. Investigating the Geographic Disparities of Amenable Mortality and Related Ambulance Services in Hungary. Int. J. Environ. Res. Public Health 2021, 18, 1065. https:// doi.org/10.3390/ijerph18031065 Received: 20 November 2020 Accepted: 22 January 2021 Published: 25 January 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; deak.mate@sph.unideb.hu (M.S.D.); nagy.attila@sph.unideb.hu (A.N.) 2 Doctoral School of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary 3 Hungarian National Ambulance Service, 1055 Budapest, Hungary; csato.gabor@mentok.hu (G.C.); papai.gyorgy@mentok.hu (G.P.) 4 Health Services Management Training Centre, Faculty of Health and Public Administration, Semmelweis University, 1125 Budapest, Hungary; dombradi.viktor@emk.semmelweis.hu 5 Department of Public Health, Government Office of the Capital City Budapest, 1138 Budapest, Hungary; nagy.csilla@kmr.antsz.hu (C.N.);juhasz.attila@kmr.antsz.hu (A.J.) 6 Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary * Correspondence: kbiro@med.unideb.hu Abstract: The aim of this study was to investigate how amenable mortality and related ambulance services differ on a county level in Hungary. The differences in mortality rates and ambulance services could identify counties where stronger ambulance services are needed. The datasets for 2018 consisted of county level aggregated data of citizens between the ages 15–64. The study examined how both the mortality rates and the ambulance rescue deliveries differ from the national average. The analyses were narrowed down to disease groups, such as acute myocardial infarction, hemorrhagic and ischemic stroke. Inequalities were identified regarding the distribution of number of ambulance deliveries, several counties had rates more than double that of the national average. For both mortality and ambulance services some of the counties had significantly better results and others had significantly worse compared to the national average. In Borsod-Abaúj-Zemplén county’s case, hemorrhagic stroke mortality was significantly higher (1.73 [1.35–2.11]), while ambulance deliveries were significantly lower (0.58 [0.40–0.76]) compared to the national average. The research has shown that regarding the investigated mortality rates and ambulance services there are considerable differences between the counties in Hungary. In this regard policy makers should implement policies to tackle these discrepancies. Keywords: amenable mortality; acute myocardial infarction; hemorrhagic stroke; ischemic stroke; ambulance service; Hungary 1. Introduction Amenable mortality is a lesser-known factor even though it could provide an accurate picture about health care systems, as it could give additional information to health care providers and decision makers at multiple levels [1,2]. “A death can be considered as amenable if it could have been avoided through optimal quality health care”[3]. It should not be confused with preventable mortality, which is ” ... broader and includes deaths which could have been avoided by public health interventions focusing on wider determinants of public health, such as be- havior and lifestyle factors, socioeconomic status and environmental factors”[3]. The combination of amenable mortality and preventable mortality is called avoidable mortality. In 2018 a set of indicators were created by a Spanish research team to measure amenable mortality [4]. In these indicators they only included disorders which can be Int. J. Environ. Res. Public Health 2021, 18, 1065. https://doi.org/10.3390/ijerph18031065 https://www.mdpi.com/journal/ijerph