Outcomes and Resource Utilization in ST-Elevation Myocardial Infarction in the United States: Evidence for Socioeconomic Disparities
Outcomes and Resource Utilization in ST-Elevation Myocardial Infarction in the United States: Evidence for Socioeconomic Disparities
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DOI：
10.1161/jaha.114.001057
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发表时间：
2014-12-01
影响因子：
5.4
通讯作者：
Menon, Venu
中科院分区：
文献类型：
--
作者：
Agarwal, Shikhar;Garg, Aatish;Menon, Venu
背景 - 住宅邮政编码状态所反映的社会经济地位（SES）可能会对许多院前临床、通路相关和运输变量产生不利影响，这些变量会影响接受再灌注的 ST 段抬高型心肌梗死（STEMI）患者的结局。我们试图分析 SES 对 STEMI 后住院死亡率、及时再灌注和住院费用的影响。方法和结果 - 我们使用 2003-2011 年全国住院患者样本数据库进行此分析。所有主要诊断为 STEMI 的入院病例均使用 ICD-9 代码进行识别。使用每位患者居住邮政编码的家庭收入中位数来评估 SES。与最高四分位数相比，最低 SES 四分位数的死亡率显着较高（OR [95% CI]：1.11 [1.06 至 1.17]）。同样，有一个非常显着的趋势，表明来自下四分位数的患者的及时再灌注逐渐减少（OR [95% CI]：0.80 [0.74 至 0.88]）。此外，与邮政编码较高的四分位患者相比，来自较低邮政编码四分位数的患者对循环支持设备的利用率较低（OR [95% CI]：0.85 [0.75 至 0.97]）。此外，与四分位数 1 相比，四分位数 2、3 和 4 的平均调整住院费用分别显着较高，分别为 913 美元、2140 美元和 4070 美元。 结论：与居住在较高 SES 邮政编码的患者相比，居住在较低 SES 邮政编码的患者住院死亡率增加，STEMI 后及时再灌注减少。来自较高SES四分位数的患者的住院费用明显高于来自较低四分位数的患者。
Background-Socioeconomic status (SES) as reflected by residential zip code status may detrimentally influence a number of prehospital clinical, access-related, and transport variables that influence outcome for patients with ST-elevation myocardial infarction (STEMI) undergoing reperfusion. We sought to analyze the impact of SES on in-hospital mortality, timely reperfusion, and cost of hospitalization following STEMI.Methods and Results-We used the 2003-2011 Nationwide Inpatient Sample database for this analysis. All hospital admissions with a principal diagnosis of STEMI were identified using ICD-9 codes. SES was assessed using median household income of the residential zip code for each patient. There was a significantly higher mortality among the lowest SES quartile as compared to the highest quartile (OR [95% CI]: 1.11 [1.06 to 1.17]). Similarly, there was a highly significant trend indicating a progressively reduced timely reperfusion among patients from lower quartiles (OR [95% CI]: 0.80 [0.74 to 0.88]). In addition, there was a lower utilization of circulatory support devices among patients from lower as compared to higher zip code quartiles (OR [95% CI]: 0.85 [0.75 to 0.97]). Furthermore, the mean adjusted cost of hospitalization among quartiles 2, 3, and 4, as compared to quartile 1 was significantly higher by $913, $2140, and $4070, respectively.Conclusions-Patients residing in zip codes with lower SES had increased in-hospital mortality and decreased timely reperfusion following STEMI as compared to patients residing in higher SES zip codes. The cost of hospitalization of patients from higher SES quartiles was significantly higher than those from lower quartiles.