Research report
Mortality after acute myocardial infarction is lower in
metropolitan regions than in non-metropolitan regions
Huy Dinh Vu, Richard F Heller, Lynette L-Y Lim, Catherine D'Este, Rachel L O'Connell
Centre for Clinical
Epidemiology and Biostatistics, The University of Newcastle, David
Maddison Clinical Sciences Building, Royal Newcastle Hospital,
Newcastle NSW 2300, Australia
Correspondence to: Professor Heller (rfhcceb{at}ibm.net)
Accepted for publication 1 February 2000
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.
DESIGNRetrospective
cohort study.
SETTING47 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.
PATIENTS1665 patients
with principal discharge diagnosis of AMI from February to June 1996.
MAIN RESULTSThere 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).
CONCLUSIONSInhospital
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
© 2000 by Journal of Epidemiology and Community Health
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