10 year trends in urban–rural disparities in treatments and outcomes after ST-elevation myocardial infarction in China: insights from the China PEACE-Retrospective Acute Myocardial Infarction Study

• Published in: The Lancet (British edition) 2015-10, Vol.386, p.S2-S2
• Main Authors: Li, Xi, PhD, Murugiah, Karthik, MD, Li, Jing, PhD, Wang, Qing, MS, Hu, Shuang, PhD, Masoudi, Frederick A, Prof, Spertus, John A, Prof, Downing, Nicholas S, MD, Chan, Paul, MD, Krumholz, Harlan M, Prof, Jiang, Lixin, Prof
• Format: Article
• Language: English
• Subjects: Capacity development; Cardiovascular diseases; Family planning; Health care; Health care access; Hospitals; Internal Medicine; Myocardial infarction; Rural areas; Urban areas
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(15)00580-2

Abstract Background In response to the epidemic transition, like in many other low-income and middle-income countries, China has been building capacities and improving access to health care in its health-care reform, with the budget favouring rural areas. Yet the trend in disparities between urban and rural areas in treatments and outcomes of ST-segment elevation myocardial infarction (STEMI) have not been well characterised. The aim of this study was to illustrate whether the quality of care for STEMI differed between urban and rural hospitals, and how it changed from 2001 to 2011. Methods Using a two-stage random sampling design including two urban and three rural strata in China, we created a nationally representative sample of patients with STEMI in China in 2001, 2006, and 2011. We collected clinical information through centralised medical chart abstraction and did surveys to determine hospital characteristics. We compared a composite outcome as in-hospital mortality or withdrawal from treatment due to a terminal status at discharge. The central ethics committee at the China National Center for Cardiovascular Diseases approved the study, with a waiver of patients' written consent. This study is registered with ClinicalTrials.gov , number NCT01624883. Findings We identified 8330 cases of STEMI in 63 urban hospitals and 5485 cases of STEMI in 99 rural hospitals. The admission rate for STEMI remained three-times higher in urban areas than in rural areas (7·4 vs 2·0 per 100 000 population in 2001; 28·1 vs 8·7 per 100 000 population in 2011; both p