title: The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data.
abstract: OBJECTIVE
  This research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI).
  
  
  METHODS
  The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a "Sistema Locale del Lavoro" (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012-2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity.
  
  
  RESULTS
  Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (p<0.001). A significant increase in total hospital days was observed (13%, p<0.001) in addition to in-hospital mortality (17%, p<0.001). As a consequence, an increase of around €350.000 was incurred in annual hospital expenditures for AMI (approximately 36%, p<0.001).
  
  
  CONCLUSIONS
  More attention should be given to the increase in health needs associated with the financial crisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity.
authors.affiliation: Department of Policy Analysis and Public Management - Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Torbica
authors.affiliation: Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy.
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Policy Analysis and Public Management - Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.|Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Ghislandi
mesh_terms: D000208:Acute Disease; D000368:Aged; D016208:Databases, Factual; D057172:Economic Recession; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000453:epidemiology / Q000401:mortality; D010351:Patient Discharge; D014478:Unemployment