In-hospital mortality after acute myocardial infarction in China: a nationwide cross-sectional analysis. (December 2017)

• Record Type: Journal Article
• Authors: Chen, Hui; Shi, Lizheng; Xue, Ming; Dong, Xiao; Wang, Ni; Chen, Jieqing; Zhu, Weiguo; Cai, Yue; Xu, Hua; Meng, Qun
• Is Part Of: Lancet. Volume 390(2017)Supplement 4
• Page Start: S44
• Publication Date: 2017-12
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(17)33182-3
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: The prevalence of acute myocardial infarction (AMI) has increased in China within the past few decades and is now a major cause of mortality. Percutaneous coronary intervention (PCI) is an effective treatment for AMI. We aimed to investigate how geographical and hospital characteristics affect in-hospital mortality and PCI use for AMI admissions in tertiary hospitals. Methods: We extracted data from the Nationwide Hospital Discharge Database from China's National Center for Health Statistics. Adjusted odds ratios (aORs) with 95% CI from multivariable logistic regressions were reported as associations between geographical variation or hospital characteristics and in-hospital mortality or PCI use, controlling for demographics and comorbidity scores. Findings: We identified 242866 adult admissions with AMI as primary diagnosis in 2015 from 1055 tertiary hospitals. The nationwide in-hospital mortality rate of AMI was 4·7% and differed significantly by geographic regions: 6·44% in northeast China; 5·84% in west China, 4·50% in south China, 3·77% in east China, and 3·60% in north China. Compared with eastern China, a high risk of in-hospital mortality was found in northeast China (aOR 1·86; 95%CI 1·75–1·98), west China (1·74; 1·62–1·86), south China (1·32; 1·24–1·40), and north China (1·14; 1·06–1·22). Hospital characteristics associated with the highest mortality were non-teaching hospitals (1·18; 1·12–1·24) and tertiary B hospitals (1·06; 1·01–1·11). The nationwide rate of PCI use was 45·3%. Compared with eastern China, PCI use was low in northeast China (0·49; 0·47–0·50), west China (0·63; 0·62–0·65), north China (0·83; 0·81–0·85), and south China (0·88; 0·86–0·91). Other factors that contributed to lowering the rate of PCI use were non-teaching hospitals (0·84; 0·81–0·865) and tertiary B hospitals (0·55; 0·53–0·56). Interpretation: Among China's tertiary hospitals, substantial disparities of in-hospital mortality and PCI use be attributable to geographical and hospital characteristics. More efforts are needed to reduce disparities and improve access to effective health technology. Funding: National Natural Science Foundation of China Grant (81671786). The funder had no role in the conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation or approval of the Abstract.