February 9, 2026SHILAP Revista de lepidopterologíaOpen Access

Association Between Inequality of Emergency Medical Supply Resources and In-Hospital Mortality in Patients With Acute Myocardial Infarction

Q: What are the key findings of this study?

Higher regional inequality in emergency medical supply resources was associated with increased in-hospital mortality in acute myocardial infarction patients; HR was 1.504 for inequality index 0.50–0.75 and 1.689 for ≥0.75 compared to lowest inequality (<=0.25).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Patients with acute myocardial infarction admitted to emergency departments in South Korea (n=53770). Intervention: Regional inequality of emergency medical supply resources measured by inequality index of emergency PCI availability vs. Regions with low inequality index (<=0.25). Primary outcome: In-hospital mortality (all-cause death during hospitalization for AMI) (HR 1.504 for inequality index 0.50–0.75; HR 1.689 for inequality index ≥0.75, 95% CI 95% CI 1.198–1.889 for index 0.50–0.75; 95% CI 1.493–1.910 for index ≥0.75, p=<0.001 by log-rank test).

Q: What does this research mean for the field?

Patients living in regions with an inequality index of emergency medical supply resources ≥0.75 had a 69% increased risk of in-hospital mortality compared to those in areas with the lowest index (<0.25). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

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Key result

Highest regional inequality in emergency medical supplies linked to ~69% higher in-hospital AMI mortality.

Why the study?

To investigate the relationship between regional inequality in emergency medical supply resources and in-hospital mortality among patients with AMI in South Korea.

Does regional inequality in emergency medical supply resources increase in-hospital mortality in patients with acute myocardial infarction?

Key Points

To evaluate the relationship between regional inequality in emergency medical supply resources and in-hospital mortality among emergency department patients with acute myocardial infarction.
Analyzed national claims data from the Korean National Health Insurance Service for N = 53,770 patients with acute myocardial infarction admitted through emergency departments between 2012 and 2020.
Calculated a regional inequality index across 256 administrative districts based on local provision versus inter-regional transfers for emergency percutaneous coronary interventions.
In-hospital mortality occurred in 4,840 of the 53,770 patients (9.0%).
Patients residing in areas with moderate-to-high resource inequality (index 0.50–0.75) demonstrated elevated in-hospital mortality risk compared with those in the lowest inequality tier (HR 1.504, 95% CI 1.198–1.889).
Living in areas with the highest resource inequality (index ≥0.75) was associated with an even greater risk of in-hospital death relative to the lowest inequality tier (HR 1.689, 95% CI 1.493–1.910).

Study Design

Type

Observational (n=53,770)

Multicenter

Yes

Structured PICO

Does regional inequality in emergency medical supply resources increase in-hospital mortality in patients with acute myocardial infarction?

Population

53,770 patients with acute myocardial infarction (AMI) admitted to emergency departments between 2012 and 2020 in South Korea.

Intervention

Residence in areas with higher inequality indices of emergency medical supply resources (index 0.25-0.49, 0.50-0.74, ≥0.75), defined by the necessity to transfer to another region for emergency percutaneous coronary intervention (PCI).

Comparator

Residence in areas with the lowest inequality index (<0.25) of emergency medical supply resources.

Outcome

In-hospital mortality (all-cause death from hospital admission to discharge or in-hospital death)hard clinical

Main Result

Effect estimate: HR 1.504 for inequality index 0.50–0.75; HR 1.689 for inequality index ≥0.75 (95% CI 95% CI 1.198–1.889 for index 0.50–0.75; 95% CI 1.493–1.910 for index ≥0.75)

p-value: p=<0.001 by log-rank test

Regional inequality in emergency medical supply resources, specifically the lack of local emergency PCI availability requiring inter-regional transfer, is significantly associated with increased in-hospital mortality among AMI patients.

Limitations

Use of claims data with approx 70% diagnostic accuracy for AMI
Unable to account for prehospital factors such as symptom onset time and treatment delays
Disease severity and clinical parameters not available in claims data
Potential residual confounding and ecological bias due to regional exposure measurement
Inability to perform further subgroup analyses due to expired data access
Accuracy of primary diagnosis code in claims data is approximately 70%.
Unable to consider prehospital factors such as symptom onset to arrival time.
Unable to determine disease severity (type of AMI, number of occluded arteries, vital signs).
Potential selection bias regarding transferred patients.
Residual confounding and ecological bias due to regional-level exposure.

Discussion

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Implication

May warrant review of regional emergency resource equity in AMI care; challenges consensus yet leaves open causal confirmation.

Abstract

Objectives This study aimed to investigate the relationship between regional inequality in emergency medical supply resources and in-hospital mortality among patients with acute myocardial infarction (AMI) in South Korea. Methods We analyzed data from the Korean National Health Insurance Service claims database, focusing on 53,770 AMI patients admitted to emergency departments between 2012 and 2020. The inequality index of emergency medical supply resources was calculated based on the availability of emergency percutaneous coronary interventions (PCI) within each region. Results Among 53,770 AMI patients, 4,840 (9.0%) died in-hospital. After adjusting for covariates, patients residing in areas with higher inequality indices had increased risk of in-hospital mortality compared to those in areas with the lowest inequality (index 0.50–0.75: HR 1.504, 95% CI 1.198–1.889; index ≥0.75: HR 1.689, 95% CI 1.493–1.910). Conclusion This study highlights the importance of equitable distribution of emergency medical resources to reduce in-hospital mortality among AMI patients. Policymakers should prioritize strategies to address regional disparities in emergency medical supply resources to improve health outcomes.

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Published by SHILAP Revista de lepidopterología · CC BY

Cite This Study

Choi et al. (2026) conducted an observational in Patients with acute myocardial infarction admitted to emergency departments in South Korea (n=53,770). Regional inequality of emergency medical supply resources measured by inequality index of emergency PCI availability vs. Regions with low inequality index (<=0.25) was evaluated on In-hospital mortality (all-cause death during hospitalization for AMI) (HR 1.504 for inequality index 0.50–0.75; HR 1.689 for inequality index ≥0.75, 95% CI 95% CI 1.198–1.889 for index 0.50–0.75; 95% CI 1.493–1.910 for index ≥0.75, p=<0.001 by log-rank test). Higher regional inequality in emergency medical supply resources was associated with increased in-hospital mortality in acute myocardial infarction patients; HR was 1.504 for inequality index 0.50–0.75 and 1.689 for ≥0.75 compared to lowest inequality (<=0.25).

synapsesocial.com/papers/69897983f0ec2af6756e740a https://doi.org/10.3389/ijph.2025.1608533

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Implication

May warrant review of regional emergency resource equity in AMI care; challenges consensus yet leaves open causal confirmation.

Association Between Inequality of Emergency Medical Supply Resources and In-Hospital Mortality in Patients With Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Figures from the paper

Cite This Study

Association Between Inequality of Emergency Medical Supply Resources and In-Hospital Mortality in Patients With Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Figures from the paper

Cite This Study

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