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Multicenter Study
. 2017 Nov;10(11):e003905.
doi: 10.1161/CIRCOUTCOMES.117.003905.

Urban-Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment-Elevation Myocardial Infarction in China From 2001 to 2011: A Retrospective Analysis From the China PEACE Study (Patient-Centered Evaluative Assessment of Cardiac Events)

Xi Li  1 , Karthik Murugiah  1 , Jing Li  1 , Frederick A Masoudi  1 , Paul S Chan  1 , Shuang Hu  1 , John A Spertus  1 , Yongfei Wang  1 , Nicholas S Downing  1 , Harlan M Krumholz  1 , Lixin Jiang  2 ; China PEACE Collaborative Group
Affiliations
Multicenter Study

Urban-Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment-Elevation Myocardial Infarction in China From 2001 to 2011: A Retrospective Analysis From the China PEACE Study (Patient-Centered Evaluative Assessment of Cardiac Events)

Xi Li et al. Circ Cardiovasc Qual Outcomes. 2017 Nov.

Abstract

Background: In response to urban-rural disparities in healthcare resources, China recently launched a healthcare reform with a focus on improving rural care during the past decade. However, nationally representative studies comparing medical care and patient outcomes between urban and rural areas in China during this period are not available.

Methods and results: We created a nationally representative sample of patients in China admitted for ST-segment-elevation myocardial infarction in 2001, 2006, and 2011, using a 2-stage random sampling design in 2 urban and 3 rural strata. In China, evidence-based treatments were provided less often in 2001 in rural hospitals, which had lower volume and less availability of advanced cardiac facilities. However, these differences diminished by 2011 for reperfusion therapy (54% in urban versus 57% in rural; P=0.1) and reversed for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (66% versus 68%; P=0.04) and early β-blockers (56% versus 60%; P=0.01). The risk-adjusted rate of in-hospital death or withdrawal from treatment was not significantly different between urban and rural hospitals in any study year, with an adjusted odds ratio of 1.13 (0.77-1.65) in 2001, 0.99 (0.77-1.27) in 2006, and 0.94 (0.74-1.19) in 2011.

Conclusions: Although urban-rural disparities in evidence-based treatment for myocardial infarction in China have largely been eliminated, substantial gaps in quality of care persist in both settings. In addition, urban hospitals providing more resource-intensive care did not achieve better outcomes.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

Keywords: ST elevation myocardial infarction; healthcare disparities; quality of health care.

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Conflict of interest statement

DISCLOSURES

There are no relevant conflicts of interest. Dr. Krumholz reports contract with Centers for Medicare & Medicaid Services to develop and maintain performance measures, research agreements with Johnson & Johnson (Janssen) and Medtronic to develop methods of clinical trial data sharing, personal fees from UnitedHealth as chair of cardiac scientific advisory board. Dr. Masoudi reports contract with American College of Cardiology for the role as Senior Medical Officer, National Cardiovascular Data Registries.

Figures

Figure 1
Figure 1. The two-stage random sampling process in China-PEACE and the selection of the cohort for the present study.
AMI indicates acute myocardial infarction; STEMI, ST-segment elevation myocardial infarction.
Figure 2
Figure 2. Differences in risk adjusted rates of in-hospital outcomes between rural and urban hospitals over time
Panel A for in-hospital death or treatment withdrawal; panel B for in-hospital complications
None
None
See this image and copyright information in PMC

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