Urban–Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment–Elevation Myocardial Infarction in China From 2001 to 2011

Background— In response to urban–rural disparities in healthcare resources, China recently launched a healthcare reform with a focus on improving rural care during the past decade. However, nationally representative studies comparing medical care and patient outcomes between urban and rural areas in China during this period are not available. Methods and Results— We created a nationally representative sample of patients in China admitted for ST-segment–elevation myocardial infarction in 2001, 2006, and 2011, using a 2-stage random sampling design in 2 urban and 3 rural strata. In China, evidence-based treatments were provided less often in 2001 in rural hospitals, which had lower volume and less availability of advanced cardiac facilities. However, these differences diminished by 2011 for reperfusion therapy (54% in urban versus 57% in rural; P =0.1) and reversed for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (66% versus 68%; P =0.04) and early β-blockers (56% versus 60%; P =0.01). The risk-adjusted rate of in-hospital death or withdrawal from treatment was not significantly different between urban and rural hospitals in any study year, with an adjusted odds ratio of 1.13 (0.77–1.65) in 2001, 0.99 (0.77–1.27) in 2006, and 0.94 (0.74–1.19) in 2011. Conclusions— Although urban–rural disparities in evidence-based treatment for myocardial infarction in China have largely been eliminated, substantial gaps in quality of care persist in both settings. In addition, urban hospitals providing more resource-intensive care did not achieve better outcomes. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01624883.