Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?
Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment.
Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders.
Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585).
Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.
2. Shah NS, Carnethon M, Lloyd-Jones DM, Khan SS. Widening rural-urban cardiometabolic mortality gap in the United States, 1999 to 2017. J Am Coll Cardiol 2020;75:3187-3188.
3. Loccoh EC, Joynt Maddox KE, Wang Y, Kazi DS, Yeh RW, Wadhera RK. Rural-urban disparities in outcomes of myocardial infarction, heart failure, and stroke in the United States. J Am Coll Cardiol 2022;79:267-279.
4. Kosar CM, Loomer L, Ferdows NB, Trivedi AN, Panagiotou OA, Rahman M. Assessment of rural-urban differences in postacute care utilization and outcomes among older US adults. JAMA Netw Open 2020;3:e1918738.
5. Hammond G, Luke AA, Elson L, Towfighi A, Joynt Maddox KE. Urban-rural inequities in acute stroke care and in-hospital mortality. Stroke 2020;51:2131-2138.
6. Nuako A, Liu J, Pham G, Smock N, James A, Baker T, Bierut L, Colditz G, Chen LS. Quantifying rural disparity in healthcare utilization in the United States: analysis of a large midwestern healthcare system. PLoS One 2022;17:e0263718.
7. Lee Liu, Rural-urban disparities in cardiovascular disease mortality among middle-age men in China. Asia Pac J Public Health 2020;32:436-439.
8. Ouyang N, Li G, Wang C, Sun Y. Construction of a risk assessment model of cardiovascular disease in a rural Chinese hypertensive population based on lasso-Cox analysis. J Clin Hypertens (Greenwich). 2022;24:38-46.
9. Li J, Shi L, Li S, Xu L, Qin W, Wang H. Urban-rural disparities in hypertension prevalence, detection, and medication use among Chinese Adults from 1993 to 2011. Int J Equity Health 2017;16:50.
10. Yu X, Zhang W. All-cause mortality rate in China: do residents in economically developed regions have better health? Int J Equity Health 2020;19:12.
11. Bhuyan SS, Wang Y, Opoku S, Lin G. Rural-urban differences in acute myocardial infarction mortality: evidence from Nebraska. J Cardiovasc Dis Res 2013;4:209-213.
12. Singh GK, Siahpush M. Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009. J Urban Health 2014;91:272-292.
13. Noor Hassim I, Norazman MR, Diana M, Khairul Hazdi Y, Rosnah I. Cardiovascular risk assessment between urban and rural population in Malaysia. Med J Malaysia 2016;71:331-337.
14. Li GX, Zhou B, Qi GX, Zhang B, Jiang DM, Wu GM, Ma B, et al. Current trends for ST-segment elevation myocardial infarction during the past 5 years in rural areas of China's Liaoning province: a multicenter study. Chin Med J (Engl) 2017;130:757-766.
15. Alston L, Allender S, Peterson K, Jacobs J, Nichols M. Rural inequalities in the Australian burden of ischaemic heart disease: a systematic review. Heart Lung Circ 2017;26:122-133.
16. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined - A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36:959-969.
17. Abbasi SH, De Leon AP, Kassaian SE, Karimi A, Sundin Ö, Jalali A, Soares J, Macassa G. Socioeconomic status and in-hospital mortality of acute coronary syndrome: Can education and occupation serve as preventive measures? Int J Prev Med 2015;6:36.
18. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/ (15 Jan 2022).
19. US Department of Health and Human Services. Healthy people 2020. http://www.healthypeople.gov (18 Jan 2022).
20. Legace C, Desmeules M, Pong RW, Heng D. Non-communicable disease and injury related mortality in rural and urban places of residence: a comparison between Canada and Australia. Can J Public Health 2007;98(Suppl 1):S62-69.
21. Gartner A, Farewell D, Dunstan F, Gordon E. Differences in mortality between rural and urban areas in England Wales, 2002-04. Health Stat Q 2008;39:6-13.
22. Gartner A, Farewell D, Roach P, Dunstan F. Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment. Soc Sci Med 2011;72:1685-1694.
23. Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: part 1-all cancers and lung cancer and part II—colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol 2011;107497:1-27.
24. Gillum RF, Mehari A, Curry B, Obisesan TO. Racial and geographic variation in coronary heart disease mortality trends. BMC Publ Health 2012;12:410.
25. Randall DA, Jorm LR, Lujic S, O’Loughlin AJ, Eades SJ, Leyland AH. Disparities in revascularization rates after acute myocardial infarction between aboriginal and non-aboriginal people in Australia. Circulation 2013;127:811-819.
26. Chew DP, French J, Briffa TG, Hammett CJ, Ellis CJ, Ranasinghe I, Aliprandi-Costa BJ, Astley CM, Turnbull FM, Lefkovits J, Redfern J, Carr B, Gamble GD, Lintern KJ, Howell TE, Parker H, Tavella R, Bloomer SG, Hyun KK, Brieger DB. Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. Med J Aust 2013;199:185-191.
27. Bertomeu V, Cequier Á, Bernal JL, Alfonso F, Anguita MP, Muñiz J, Barrabés JA, García-Dorado D, Goicolea J, Elola FJ. In-hospital mortality due to acute myocardial infarction. Relevance of type of hospital and care provided. RECALCAR study. Rev Esp Cardiol (Engl Ed) 2013;66:935-942.
28. Ebrahimi M, Kazemi-Bajestani SM, Ghayour-Mobarhan M, Ferns GA. Coronary artery disease and its risk factors status in Iran: a review. Iran Red Crescent Med J 2011;13:610-623.
29. O'Connor A, Wellenius G. Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health 2012;126:813-820.
30. Almeida L, Szklo A, Sampaio M, Souza M, Martins LF, Szklo M, Malta D, Caixeta R. Global Adult Tobacco Survey data as a tool to monitor the WHO Framework Convention on Tobacco Control (WHO FCTC) implementation: The Brazilian case. Int J Environ Res Public Health 2012;9; 2520-2536.
31. Vander Weg MW, Cunningham CL, Howren MB, Cai X. Tobacco use and exposure in rural areas: findings from the Behavioral Risk Factor Surveillance System. Addict Behav 2011;36: 231-236.
32. Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital Health Stat 2012;10:1-207.
33. Houehanou YCN, Lacroix P, Mizehoun GC, Preux PM, Marin B, Houinato DS. Magnitude of cardiovascular risk factors in rural and urban areas in Benin: findings from a nationwide steps survey. PLoS One 2015;10:e0126441.
34. Samuel P, Antonisamy B, Raghupathy P, Richard J, Fall CH. Socioeconomic status and cardiovascular risk factors in rural and urban areas of Vellore, Tamilnadu, South India. Int J Epidemiol 2012;41:1315-1327.
35. Miranda JJ, Gilman RH, Smeeth L. Differences in cardiovascular risk factors in rural, urban and rural-to-urban migrants in Peru. Heart 2011;97:787-796.
36. Haase A, Steptoe A, Sallis JF, Wardle J. Leisure-time physical activity in university students from 23 countries: associations with health beliefs, risk awareness, and national economic development. Prev Med 2004;39:182-190.
37. Farhud DD. Impact of lifestyle on health. Iran J Public Health 2015;44:1442-1444.
38. Moore M, Gould P, Keary BS. Global urbanization and impact on health. Int J Hyg Environ Health 2003;206:269-278.
|Issue||Vol 17 No 2 (2022): J Teh Univ Heart Ctr|
|Rural Population Rural Health Urban Health Acute Coronary Syndrome Hospital Mortality|
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