# An Analysis Of The Multi-Level Factors That Impact Provision Of Emergency Medical Services To Hispanic Older Adults

> **NIH NIH R36** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2024 · $41,469

## Abstract

Project Summary/Abstract
Hispanics are one of the fastest growing populations of older adults in the United States (U.S.). From 2019 to 2060, the
population of Hispanic older adults aged 65 years and over in the U.S. is projected to increase from 9% to 21%. Existing
literature suggests that Hispanic older adults experience health disparities across multiple sectors of the U.S. healthcare
system, including emergency medicine. Emergency medical services (EMS) provided in the prehospital setting, however,
are a largely understudied sector in the U.S. healthcare system, especially in the context of Hispanic older adults. EMS
serve as an important entry point into the U.S. healthcare system for Hispanic older adults who often have challenges
accessing preventive and diagnostic care. The objectives of the proposed dissertation are three-fold: 1) assess the
individual, neighborhood, and structural-level factors that impact the provision of EMS care by emergency medical
technicians and paramedics to Hispanic older adults; 2) examine the individual and neighborhood-level factors that impact
the provision of EMS to Hispanic older adults experiencing a high-acuity, time sensitive, cardiac-related 9-1-1
emergency; and 3) determine the individual and neighborhood-level factors that impact the provision of EMS for Hispanic
older adults experiencing a psychiatric-related 9-1-1 emergency, a type of call often triaged as low acuity. The National
Institute of Aging’s Health Disparities Framework provides the theoretical foundation for the three studies that comprise
this dissertation. The first study in this dissertation is a systematic literature review, an increasingly important approach to
synthesize existing literature and provide justification for future research. The second and third studies use data from three
sources, including the San Francisco Department of Emergency Management, San Francisco Department of Public
Health, and the 2020 and 2021 American Community Survey. The PRISMA 2020 guidelines and Covidence software
inform the completion of the systematic literature review, which addresses the first objective. Logistic regression and
multilevel modeling are used to: 1) examine the association between individual and neighborhood-level factors and high-
acuity, cardiac-related 9-1-1 emergency calls, which address the second objective; and 2) assess the association between
individual and neighborhood-level factors with low-acuity, psychiatric-related 9-1-1 emergency calls, which address the
third objective. Neighborhood in the second and third objectives refers to ZIP code as the level of geospatial analysis.
Stata 17.0 and R are used to run the statistical analyses in the second and third studies. The proposed dissertation will
offer insights on the provision of EMS to Hispanic older adults. The findings from this dissertation can inform ongoing
efforts to make the EMS system more accessible, age-friendly, and equitable.

## Key facts

- **NIH application ID:** 10891115
- **Project number:** 1R36AG087312-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** Esmeralda Melgoza
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $41,469
- **Award type:** 1
- **Project period:** 2024-07-15 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10891115

## Citation

> US National Institutes of Health, RePORTER application 10891115, An Analysis Of The Multi-Level Factors That Impact Provision Of Emergency Medical Services To Hispanic Older Adults (1R36AG087312-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10891115. Licensed CC0.

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