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Rural areas of the USA increasingly experience higher all-cause mortality than urban areas.1 Geographic variability in socioeconomic, racial/ethnic, lifestyle and metabolic characteristics accounts for some, but not all, of this disparity.2 The remaining excess mortality might be driven by disparities in emergency care access because rural residents often live in ‘ambulance deserts’ greater than 25 min from an ambulance station.3 Emergency care–sensitive conditions (ECSCs) are time-sensitive conditions (eg, stroke, myocardial infarction) for which emergency care can prevent mortality.4 We hypothesise that reduced access to emergency care in ambulance deserts contributes to excess ECSC mortality as compared with all other causes of death (non-ECSC).