Association of Socioeconomic, Racial, and Regional Factors with In-Hospital Management and Outcomes of Acute Myocardial Infarction Patients in the United States: National Analyses of 2.8 Million Admissions
Abstract
Social determinants of health contribute to variations in clinical outcomes among acute myocardial infarction (AMI) patients. Using the National Inpatient Sample, we conducted retrospective cohort analyses to evaluate the association of income, race, and geography with in-hospital mortality and revascularization procedures among AMI admissions in the United States from 2015 to 2019. Multilevel logistic regression models were used while accounting for hospital clustering and relevant predictors. A sequential model-building approach produced model 1 (unadjusted patient-level exposures), model 2 (lifestyle factors), model 3 (clinical characteristics), and model 4 (fully adjusted hospital-level factors). We identified 2,798,225 AMI hospitalizations (≥18 years) with 1,567,575 undergoing revascularization procedures. Lowest-income, White, Asian or Pacific Islander, Native American, and Southern residents had higher in-hospital mortality, while higher-income, White, Midwestern, Southern, and Western residents had greater use of revascularization procedures. System-level strategies that improve structural factors are recommended to reduce disparities in AMI outcomes.