Cross-sectional study
Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries
- Serial cross-sectional cohort study
- population-representative administrative data
- 6 countries
Authors' conclusion
High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries.
Study context
- Population
- Adults aged ≥66 years hospitalized with acute MI, 2013–2018, in the US, Canada, England, the Netherlands, Taiwan and Israel
- Exposure
- High-income vs low-income patients
- Outcome
- 30-day and 1-year mortality
Main finding
Mortality (30-day and 1-year)
Difference
−2.8 percentage points
95% CI −4.1 to −1.5
High income vs Low income
difference −2.8 percentage points (95% CI −4.1 to −1.5)
As reported in the abstract
- 1-year mortality, STEMI, Israel (largest difference): 16.2% vs 25.3%
- −9.1 percentage points (95% CI, −16.7 to −1.6)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | High income | Low income | difference (percentage points) (95% CI) | |
|---|---|---|---|---|
| Cardiac catheterization and PCI · PCI, STEMI, England | 73.6% | 67.4% | 6.1 (1.2–11.0) | |
| CABG · NSTEMI, US | 12.5% | 11.0% | 1.5 (1.3–1.8) | |
| −5051015Difference, percentage points (linear scale) |
- Cardiac catheterization and PCI — Higher among high- vs low-income in all countries; absolute differences
- 1 to 6 percentage points
- CABG — non-STEMI (NSTEMI): generally higher among high-income patients
- 1 to 2 percentage points
CABG
- STEMI: similar in low- vs high-income strata
30-day readmission and length of stay
- 30-day readmission generally lower for high-income patients
- 1 to 3 percentage points
- Length of stay generally shorter for high-income patients
- 0.2 to 0.5 days
Original publication
Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. JAMA. Published 4 April 2023. doi:10.1001/jama.2023.1699
Summarised from the published abstract; every number is checked against it