title: Factors attributed to the higher in-hospital mortality of ST elevation myocardial infarction patients admitted during off-hour in comparison with those during regular hour.
abstract: BACKGROUND
  In-hospital mortality of patients with ST elevation myocardial infarction (STEMI) admitted during off-hour was reported higher than those admitted during regular hour, but which factors cause the difference remains largely unknown though the difference in medical resources was often accused.
  
  
  RESULTS
  This registry-based study recruited 7456 STEMI patients prospectively from 99 level two hospitals across China. Generalized linear mixed models were applied to quantify the risk of in-hospital death attributed to admission time and the explainers of its change, accounting for the clustering of patients within hospitals. There were 45.2% patients admitted during regular hour and 54.8% during off-hour. In-hospital mortality was 7.0% for patients admitted during regular hour and 8.3% for those during off-hour (p<0.05). Generalized linear mixed models adjusting for age, gender and education showed that patients' disease severity at admission and medical treatments received after admission could explain the risk difference attributed to admission time by 55% and 20%, respectively. After all factors accounted, the residual relative risk difference left only 6% (adjusted OR = 0.94) and became no longer significant.
  
  
  CONCLUSIONS
  The regular-and-off-hour mortality difference exists among STEMI patients in Chinese level two hospitals, which could be attributed primarily to disease severity at admission and secondly to the poorer medical treatments. These results call for public attention to the more severity of STEMI patients admitted during off-hour in addition to improving medical resources for STEMI at off-hour.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Shenshen
authors.initials: S
authors.lastname: Li
authors.affiliation: Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Xian
authors.initials: X
authors.lastname: Li
authors.affiliation: Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Changsheng
authors.initials: C
authors.lastname: Ma
authors.affiliation: Peking University First Hospital, Beijing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Huo
authors.affiliation: Peking University People's Hospital, Beijing, China.
authors.forename: Dayi
authors.initials: D
authors.lastname: Hu
authors.affiliation: The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China.
authors.forename: Runlin
authors.initials: R
authors.lastname: Gao
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.|The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Yangfeng
authors.initials: Y
authors.lastname: Wu
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality*