title: Mortality after acute myocardial infarction is lower in metropolitan regions than in non-metropolitan regions.
abstract: OBJECTIVE
  To compare in-hospital mortality for acute myocardial infarction (AMI) between metropolitan and non-metropolitan hospitals after adjustment for patients' severity; to examine the role of the use of effective cardiac medications in the possible mortality difference between these types of hospital.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  47 acute public hospitals in metropolitan and non-metropolitan areas of New South Wales, Australia, taking part in the Acute Cardiac Care Project based on medical record review.
  
  
  METHODS
  1665 patients with principal discharge diagnosis of AMI from February to June 1996.
  
  
  RESULTS
  There was no difference in crude mortality rate (assessed as seven day mortality) between metropolitan and non-metropolitan hospitals (11.0% compared with 10.7% respectively, p=0.893). After adjustment for severity in a logistic regression model, the odds of death in non-metropolitan hospitals was significantly higher than in metropolitan hospitals (odds ratio = 1. 90; 95% CI 1.21, 3.23). The addition of the use of effective cardiac medications to the model resulted in the difference between hospital type becoming non-significant (odds ratio=1.09; 95% CI 0.57, 2.07).
  
  
  CONCLUSIONS
  In-hospital mortality in non-metropolitan hospitals was higher than that in metropolitan hospitals, after adjustment for patients' severity. This might partly be explained by the difference in use of effective cardiac medications between hospital type.
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, David Maddison Clinical Sciences Building, Royal Newcastle Hospital, Newcastle NSW 2300, Australia.
authors.forename: H D
authors.initials: HD
authors.lastname: Vu
authors.forename: R F
authors.initials: RF
authors.lastname: Heller
authors.forename: L L
authors.initials: LL
authors.lastname: Lim
authors.forename: C
authors.initials: C
authors.lastname: D'Este
authors.forename: R L
authors.initials: RL
authors.lastname: O'Connell
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D016896:Treatment Outcome