Abstract 13850: Outcomes and Resource Utilization in ST Elevation Myocardial Infarction in the United States: Evidence for socioeconomic disparities

Abstract

Background: Socioeconomic status (SES) as reflected by residential zip code status may detrimentally influence a number of pre-hospital clinical, access-related and transport variables that influence outcome for patients with ST-elevation myocardial infarction (STEMI) undergoing reperfusion. We sought to analyze the relationship between SES and in-hospital mortality following STEMI. Methods: We used the 2003-2011 US Nationwide Inpatient Sample for this study. All admissions with a principal diagnosis of STEMI were identified using standard ICD codes. SES was classified based on median household income of the residential zip code of every patient. In-hospital death and timely reperfusion within day 0 of presentation were the primary outcomes for the study. Results: A total of 372984 admissions with STEMI were analyzed. There was a significantly higher mortality among the lowest SES quartile as compared to the highest quartile [OR (95% CI): 1.11(1.06-1.17)] (Fig). There was a highly significant trend indicating a progressively reduced timely reperfusion among patients from lower quartiles [OR (95% CI): 0.80 (0.74-0.88)] (Fig). In addition, there was a greater utilization of circulatory support devices and Swan Ganz catheterization among patients from higher as compared to lower quartiles (Fig). Furthermore, the mean adjusted cost of hospitalization among quartiles 2,3, and 4, as compared to quartile 1 was significantly higher by $913, $2140 and $4070 respectively. Conclusions: Patients residing in zip codes with lower SES had increased mortality and decreased timely reperfusion following STEMI as compared to patients residing in higher SES zip codes. Despite higher mortality, the utilization of circulatory support devices and Swan Ganz catheterization was paradoxically lower among patients from lower SES zip codes. In addition, cost of hospitalization of patients from higher SES quartiles was significantly higher than those from lower quartiles.