Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2000 Aug;54(8):590–595. doi: 10.1136/jech.54.8.590

Mortality after acute myocardial infarction is lower in metropolitan regions than in non-metropolitan regions

H D Vu 1, R Heller 1, L Lim 1, C D'Este 1, R O'Connell 1
PMCID: PMC1731723  PMID: 10890870

Abstract

STUDY OBJECTIVES—To compare inhospital mortality for acute myocardial infarction (AMI) between metropolitan and non-metropolitan hospitals after adjustment for patients' severity; to examine the role of the use of effective cardiac medications in the possible mortality difference between these types of hospital.
DESIGN—Retrospective cohort study.
SETTING—47 acute public hospitals in metropolitan and non-metropolitan areas of New South Wales, Australia, taking part in the Acute Cardiac Care Project based on medical record review.
PATIENTS—1665 patients with principal discharge diagnosis of AMI from February to June 1996.
MAIN RESULTS—There was no difference in crude mortality rate (assessed as seven day mortality) between metropolitan and non-metropolitan hospitals (11.0% compared with 10.7% respectively, p=0.893). After adjustment for severity in a logistic regression model, the odds of death in non-metropolitan hospitals was significantly higher than in metropolitan hospitals (odds ratio = 1.90; 95% CI 1.21, 3.23). The addition of the use of effective cardiac medications to the model resulted in the difference between hospital type becoming non-significant (odds ratio=1.09; 95% CI 0.57, 2.07).
CONCLUSIONS—Inhospital mortality in non-metropolitan hospitals was higher than that in metropolitan hospitals, after adjustment for patients' severity. This might partly be explained by the difference in use of effective cardiac medications between hospital type.


Keywords: inhospital mortality; myocardial infarction; regional differences

Full Text

The Full Text of this article is available as a PDF (127.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Casale P. N., Jones J. L., Wolf F. E., Pei Y., Eby L. M. Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction. J Am Coll Cardiol. 1998 Oct;32(4):885–889. doi: 10.1016/s0735-1097(98)00325-8. [DOI] [PubMed] [Google Scholar]
  2. Dillner L. Scottish death rates published with health warning. BMJ. 1994 Dec 17;309(6969):1599–1600. doi: 10.1136/bmj.309.6969.1599a. [DOI] [PubMed] [Google Scholar]
  3. Dobson A. J., Jamrozik K. D., Hobbs M., Heller R. F., Steele P. L., Parsons R., Thompson P. Medical care and case fatality from myocardial infarction and coronary death in Newcastle and Perth. Aust N Z J Med. 1993 Feb;23(1):12–18. doi: 10.1111/j.1445-5994.1993.tb00531.x. [DOI] [PubMed] [Google Scholar]
  4. Dubois C., Pierard L. A., Albert A., Smeets J. P., Demoulin J. C., Boland J., Kulbertus H. E. Short-term risk stratification at admission based on simple clinical data in acute myocardial infarction. Am J Cardiol. 1988 Feb 1;61(4):216–219. doi: 10.1016/0002-9149(88)90918-6. [DOI] [PubMed] [Google Scholar]
  5. Fitzpatrick J. M., Manderson L. Health at the margins: providing services in remote areas and for marginal populations. Aust J Public Health. 1995 Dec;19(6):547–548. doi: 10.1111/j.1753-6405.1995.tb00457.x. [DOI] [PubMed] [Google Scholar]
  6. Hand R., Klemka-Walden L., Inczauskis D. Rural hospital mortality for myocardial infarction in Medicare patients in Illinois. Am J Med Qual. 1996 Fall;11(3):135–141. doi: 10.1177/0885713X9601100304. [DOI] [PubMed] [Google Scholar]
  7. Jollis J. G., DeLong E. R., Peterson E. D., Muhlbaier L. H., Fortin D. F., Califf R. M., Mark D. B. Outcome of acute myocardial infarction according to the specialty of the admitting physician. N Engl J Med. 1996 Dec 19;335(25):1880–1887. doi: 10.1056/NEJM199612193352505. [DOI] [PubMed] [Google Scholar]
  8. Kahn K. L., Brook R. H., Draper D., Keeler E. B., Rubenstein L. V., Rogers W. H., Kosecoff J. Interpreting hospital mortality data. How can we proceed? JAMA. 1988 Dec 23;260(24):3625–3628. [PubMed] [Google Scholar]
  9. Kahn K. L., Rogers W. H., Rubenstein L. V., Sherwood M. J., Reinisch E. J., Keeler E. B., Draper D., Kosecoff J., Brook R. H. Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. JAMA. 1990 Oct 17;264(15):1969–1973. [PubMed] [Google Scholar]
  10. Keeler E. B., Kahn K. L., Draper D., Sherwood M. J., Rubenstein L. V., Reinisch E. J., Kosecoff J., Brook R. H. Changes in sickness at admission following the introduction of the prospective payment system. JAMA. 1990 Oct 17;264(15):1962–1968. [PubMed] [Google Scholar]
  11. Keeler E. B., Rubenstein L. V., Kahn K. L., Draper D., Harrison E. R., McGinty M. J., Rogers W. H., Brook R. H. Hospital characteristics and quality of care. JAMA. 1992 Oct 7;268(13):1709–1714. [PubMed] [Google Scholar]
  12. Orchard C. Comparing healthcare outcomes. BMJ. 1994 Jun 4;308(6942):1493–1496. doi: 10.1136/bmj.308.6942.1493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Selker H. P. Systems for comparing actual and predicted mortality rates: characteristics to promote cooperation in improving hospital care. Ann Intern Med. 1993 May 15;118(10):820–822. doi: 10.7326/0003-4819-118-10-199305150-00010. [DOI] [PubMed] [Google Scholar]
  14. Thiemann D. R., Coresh J., Oetgen W. J., Powe N. R. The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med. 1999 May 27;340(21):1640–1648. doi: 10.1056/NEJM199905273402106. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES