Association of Hospital Racial Composition and Payer Mix With Mortality in Acute Coronary Syndrome

J Am Heart Assoc. 2019 Nov 5;8(21):e012831. doi: 10.1161/JAHA.119.012831. Epub 2019 Oct 18.

Abstract

Background Patient characteristics insufficiently explain disparities in cardiovascular outcomes among hospitalized patients, suggesting a role for community or hospital-level factors. Here, we evaluate the association of hospital racial composition and payer mix with all-cause inpatient mortality for patients hospitalized with acute coronary syndrome (ACS). Methods and Results Using the National Inpatient Sample, we identified adult hospitalizations from 2014 with a primary diagnosis of ACS (n=550 005). We divided National Inpatient Sample hospitals into quartiles based on percent of minority (black, Hispanic, Asian or Pacific Islander, Native American race/ethnicity) and low-income payer (Medicaid or uninsured) discharges in 2014. We utilized logistic regression to determine whether hospital minority or low-income payer makeup associated with all-cause inpatient mortality among those admitted for ACS . In adjusted models, ACS patients admitted to hospitals with >12.4% to 25.4% (Quartile 2), >25.4% to 44.3% (Q3), and >44.3% (Q4) minority discharges experienced a 14% (OR 1.14, 95% CI 1.06-1.23), 13% (OR 1.13, 95% CI 1.04-1.23), and 15% (OR 1.15, 95% CI 1.04-1.26) increased odds of all-cause inpatient mortality compared with hospitals with ≤12.4% (Q1) minority discharges. ACS patients admitted to hospitals with >18.7% to 25.7% (Q2) and >34.0% (Q4) low-income payer discharges experienced a 9% (OR 1.09, 1.01-1.17) and 9% (OR 1.09, 1.00-1.19) increased odds of all-cause inpatient mortality when compared with hospitals with ≤18.7% (Q1) low-income payer discharges. Conclusions Hospital minority and low-income payer makeup positively associate with odds of all-cause inpatient mortality among patients admitted for acute coronary syndrome.

Keywords: acute coronary syndrome; health services research; quality of care; race and ethnicity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / mortality*
  • Acute Coronary Syndrome / therapy
  • Aged
  • Coronary Angiography / statistics & numerical data
  • Datasets as Topic
  • Female
  • Heart Arrest / epidemiology
  • Hospital Mortality
  • Hospitalization*
  • Humans
  • Male
  • Medicaid / statistics & numerical data
  • Medically Uninsured / statistics & numerical data*
  • Medicare / statistics & numerical data*
  • Middle Aged
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Racial Groups / statistics & numerical data*
  • Renal Dialysis / statistics & numerical data
  • Respiration, Artificial / statistics & numerical data
  • United States / epidemiology