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Original Article

JCDR. 2013; 4(4): 209-213

Ruraleurban differences in acute myocardial infarction mortality: Evidence from Nebraska

Soumitra Sudip Bhuyan, Yang Wang, Samuel Opoku, Ge Lin.


Aims: Acute myocardial infarction (AMI) remains a major cause of death and disability in the United
States and worldwide. Despite the importance of surveillance and secondary prevention, the incidence of
and mortality from AMI are not continuously monitored, and little is known about survival outcomes
after 30 days of AMI hospitalization or associated risk factors, especially in the rural areas. The current
study examines ruraleurban differences in both in- and out-hospital survival outcomes for AMI patients.
Methods: We performed a retrospective analysis using hospital discharge data in Nebraska for January
2005 to December 2009 and Nebraska death certificate records through October 2011. Multivariate logistic
regression was used to estimate the ruraleurban difference in 30-day mortality. A Cox proportional
hazard model was used to predict out-of-hospital and overall survival rate.
Results: In the 30-day mortality model, after controlling for age, comorbidities, and rehabilitation,
patients in urban areas were less likely to die than patients in rural areas (odds ratio: 0.709, 95%
confidence interval: 0.626e0.802). In the overall survival model, patients in urban areas had a lower
hazard of AMI death (hazard ratio: 0.86, 95% confidence interval: 0.806e0.931) than patients in rural
areas. Patients with a previous history of heart failure had a significantly higher likelihood of 30-day
mortality, while atrial fibrillation, heart failure, and chronic kidney disease were associated with lower
overall survival. Patients who attended at least 1 cardiac rehabilitation session had significantly lower
30-day and overall mortality (p < 0.0001).
Conclusions: This study confirms previous findings on ruraleurban disparities in 30-day mortality
following AMI hospitalization, and reports new findings on overall ruraleurban mortality disparity. The
study also found an association between cardiac rehabilitation and reduced mortality, a finding never
before reported at the population level. Further efforts are needed to develop systems in rural hospitals
and communities to ensure that AMI patients receive recommended care.

Key words: Acute myocardial infarction Rural health Acute myocardial infarction survival difference

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