In-hospital mortality after acute myocardial infarction in China: a nationwide cross-sectional analysis

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.