Recent Declines in Hospitalizations for Acute Myocardial Infarction for Medicare Fee-for-Service Beneficiaries Progress and Continuing Challenges

被引:120
作者
Chen, Jersey [1 ]
Normand, Sharon-Lise T. [2 ,3 ]
Wang, Yun [4 ]
Drye, Elizabeth E. [4 ]
Schreiner, Geoffrey C. [4 ]
Krumholz, Harlan M. [1 ,4 ,5 ,6 ]
机构
[1] Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06520 USA
[2] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
[3] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[4] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA
[5] Yale Univ, Sch Med, Dept Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06520 USA
[6] Yale Univ, Sch Publ Hlth, Sect Hlth Policy & Adm, Sch Med, New Haven, CT 06520 USA
关键词
epidemiology; infarction; vital statistics; CORONARY-HEART-DISEASE; POSITIVE PREDICTIVE-VALUE; STATIN THERAPY; UNITED-STATES; RECENT TRENDS; RISK-FACTORS; WHITE WOMEN; MORTALITY; RATES; CARE;
D O I
10.1161/CIRCULATIONAHA.109.862094
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Amid recent efforts to reduce cardiovascular risk, whether rates of acute myocardial infarction (AMI) in the United States have declined for elderly patients is unknown. Methods and Results-Medicare fee-for-service patients hospitalized in the United States with a principal discharge diagnosis of AMI were identified through the use of data from the Centers for Medicare and Medicaid Services from 2002 to 2007, a time period selected to reduce changes arising from the new definition of AMI. The Medicare beneficiary denominator file was used to determine the population at risk. AMI hospitalization rates were calculated annually per 100 000 beneficiary-years with Poisson regression analysis and stratified according to age, sex, and race. The annual AMI hospitalization rate in the fee-for-service Medicare population fell from 1131 per 100 000 beneficiary-years in 2002 to 866 in 2007, a relative 23.4% decline. After adjustment for age, sex, and race, the AMI hospitalization rate declined by 5.8%/y. From 2002 to 2007, white men experienced a 24.4% decrease in AMI hospitalizations, whereas black men experienced a smaller decline (18.0%; P<0.001 for interaction). Black women had a smaller decline in AMI hospitalization rate compared with white women (18.4% versus 23.3%, respectively; P<0.001 for interaction). Conclusions-AMI hospitalization rates fell markedly in the Medicare fee-for-service population between 2002 and 2007. However, black men and women appeared to have had a slower rate of decline compared with their white counterparts. (Circulation. 2010; 121: 1322-1328.)
引用
收藏
页码:1322 / 1328
页数:7
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