Abstract 15070: Young Age Single Largest Predictor of Variation in Acute Myocardial Infarction Hospitalizations Nationwide
Background: Geographic variations in hospitalization and mortality rates for acute myocardial infarction (AMI) are well-recognized. However, much work exploring disparities in AMI has focused on older Medicare beneficiaries. Little is known about the impact of age on variation in AMI hospitalizations.
Methods: Using nationally representative administrative data from the 2007-2008 Healthcare Cost and Utilization Project (HCUP) and U.S. Census 2007-2008 estimated population data, we constructed a mixed effects model to examine the geographic variations in AMI hospitalizations, in-hospital mortality, and length of stay (LOS) for younger (age <65) versus older ( ≥65) adults across 42 states that participated in HCUP. Geographic variation was assessed by the risk-adjusted between-state variance drawn from the mixed effects model. Analyses were weighted by a sampling weight included in the HCUP data.
Results: Our study sample included 253,964 AMI discharges from 2007-2008. Although there was significant geographic variation in LOS and AMI mortality rates (p <0.001), patterns of variation were similar between older and younger patients. However, variation in hospitalization rates was significantly different between younger and older adults, such that the variation in risk-adjusted odds of adults <65 being hospitalized for AMI was 14.8 (95% CI 7.14-26.1) vs 2.6 (95% CI 1.98-3.15) for adults age ≥65 (figure).
Conclusion: Using a nationally representative dataset, we found significant state-level variation in hospitalization rates for AMI that was dramatically increased in younger patients compared with older patients. While much quality improvement work has focused on reducing variation in AMI hospitalizations and care for older adults, our study suggests that substantial opportunities for improvement remain in standardizing the management of younger patients with AMI nationwide.
- © 2012 by American Heart Association, Inc.