Key result
Rural hospitals were associated with a higher risk of in-hospital mortality for acute myocardial infarction (OR 1.19), an inequality that was fully mediated by the lower use of percutaneous coronary intervention in rural settings.
Why the study?
To determine to what extent inequality in the ability to provide PCI translates into outcomes for AMI patients in China.
Does admission to a rural versus urban hospital affect in-hospital mortality in patients with acute myocardial infarction, and is this disparity mediated by percutaneous coronary intervention rates?
Observational (n=82,677)
Yes
Does admission to a rural versus urban hospital affect in-hospital mortality in patients with acute myocardial infarction, and is this disparity mediated by percutaneous coronary intervention rates?
The disparity in in-hospital mortality for acute myocardial infarction patients between rural and urban hospitals in China is fully mediated by the lower utilization of percutaneous coronary intervention in rural settings.
Rural AMI mortality linked to lower PCI access; leaves open whether expanding rural PCI capacity narrows disparities.
Objectives: To determine to what extent the inequality in the ability to provide percutaneous coronary intervention (PCI) translates into outcomes for AMI patients in China. Methods: We identified 82,677 patients who had primary diagnoses of AMI and were hospitalized in Shanxi Province, China, between 2013 and 2017. We applied logistic regressions with inverse probability weighting based on propensity scores and mediation analyses to examine the association of hospital rurality with in-hospital mortality and the potential mediating effects of PCI. Results: In multivariate models where PCI was not adjusted for, rural hospitals were associated with a significantly higher risk of in-hospital mortality (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.03–1.37). However, this association was nullified (OR: 0.94, 95% CI: 0.81–1.08) when PCI was included as a covariate. Mediation analyses revealed that PCI significantly mediated 132.3% (95% CI: 104.1–256.6%) of the effect of hospital rurality on in-hospital mortality. The direct effect of hospital rurality on in-hospital mortality was insignificant. Conclusion: The results highlight the need to improve rural hospitals’ infrastructure and address the inequalities of treatments and outcomes in rural and urban hospitals.
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Cai et al. (2022) conducted an observational in Acute Myocardial Infarction (n=82,677). Hospital rurality vs. Urban hospitals was evaluated on In-hospital mortality (OR 1.19, 95% CI 1.03-1.37). Rural hospitals were associated with a higher risk of in-hospital mortality for acute myocardial infarction (OR 1.19), an inequality that was fully mediated by the lower use of percutaneous coronary intervention in rural settings.
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