Geographic disparities in the incidence and outcomes of hospitalized myocardial infarction: does a rising tide lift all boats?
نویسندگان
چکیده
BACKGROUND Improvements in prevention have led to declines in incidence and mortality of myocardial infarction (MI) in selected populations. However, no studies have examined regional differences in recent trends in MI incidence, and few have examined whether known regional disparities in MI care have narrowed over time. METHODS AND RESULTS We compared trends in incidence rates of MI, associated procedures and mortality for all US Census Divisions (regions) in Medicare fee-for-service patients between 2000-2008 (292 773 151 patient-years). Two-stage hierarchical models were used to account for patient characteristics and state-level random effects. To assess trends in geographic disparities, we calculated changes in between-state variance for outcomes over time. Although the incidence of MI declined in all regions (P<0.001 for trend for each) between 2000-2008, adjusted rates of decline varied by region (annual declines ranging from 2.9-6.1%). Widening geographic disparities, as measured by percent change of between-state variance from 2000-2008, were observed for MI incidence (37.6% increase, P=0.03) and percutaneous coronary intervention rates (31.4% increase, P=0.06). Significant declines in risk-adjusted 30-day mortality were observed in all regions, with the fastest declines observed in states with higher baseline mortality rates. CONCLUSIONS In a large contemporary analysis of geographic trends in MI epidemiology, the incidence of MI and associated mortality declined significantly in all US Census Divisions between 2000-2008. Although geographic disparities in MI incidence may have increased, regional differences in MI-associated mortality have narrowed.
منابع مشابه
Does a Rising Tide Lift All Boats?
Last year, an Institute of Medicine panel identified health care delivery and disparities as the nation’s top 2 priorities for comparative effectiveness research.1 We have long known that disparities in the delivery of cardiovascular care are pervasive and harmful; the literature is robust and clear. These disturbing disparities are most prominent for emerging hightechnology procedures. Compare...
متن کاملDoes a Rising Biofuels Tide Raise All Boats? A Study of Cash Rent Determinants for Iowa Farmland under Hay and Pasture
متن کامل
A two-year survey on the effect of temperature changes on the incidence of myocardial infarction in patients referred to the Ali-ibn Abi Talib Hospital, Rafsanjan, Iran, in 2013-2014
Background: The role of temperature changes, as an environmental risk factor, in the human health status has been investigated in recent studies. Accordingly, the present two-year study was conducted to evaluate the incidence of myocardial infarction (MI) in warm and cold seasons in Ali-ibn Abi Talib Hospital, Rafsanjan, Iran. Materials and Methods: In this descriptive and cross-sectional st...
متن کاملبررسی اپیدمیولوژیک بیماران با انفارکتوس حاد میوکارد در بیمارستان سیدالشهداء(ع) ارومیه در شش ماهه اول 1390
Background & Aims: Acute myocardial infarction (AMI) is the most serious and fatal form of coronary heart diseases. Despite advances in diagnosis and management, acute myocardial infarction continues to be a major health problem in the industrialized world and significantly is rising in developing countries. Various epidemiological studies have been conducted in order to investigate the cause...
متن کاملTrends in the Prevalence of Diabetes Mellitus in Patients with Myocardial Infarction in the South of Iran: 2008 to 2014
Background: Diabetes mellitus is a strong risk factor for cardiovascular disease, including acute myocardial infarction (AMI). Management of risk factors and the other prevention services in recent years lead to a significant decrease in AMI incidence. However, to examine the success of those strategies to control diabetes, this study aimed to identify the trends in prevalence of diabetes melli...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Circulation. Cardiovascular quality and outcomes
دوره 5 2 شماره
صفحات -
تاریخ انتشار 2012