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Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010
Study Questions:
What are the sex differences in clinical characteristics, hospitalization rates, length of stay (LOS), and in-hospital mortality by age group and race among young patients with acute myocardial infarctions (AMIs) using a large national dataset of US hospital discharges?
Methods:
Using the National Inpatient Sample, clinical characteristics, AMI hospitalization rates, LOS, and in-hospital mortality were compared for patients with AMI across ages 30-54 years, dividing them into 5-year subgroups from 2001 to 2010, using survey data analysis techniques. The authors assessed annual changes in in-hospital mortality rate and mean LOS using linear regression.
Results:
A total of 230,684 hospitalizations were identified with principal discharge diagnoses of AMI in 30- to 54-year-old patients from Nationwide Inpatient Sample data, representing an estimated 1,129,949 hospitalizations in the United States from 2001 to 2010. No statistically significant declines in AMI hospitalization rates were observed in the age groups <55 years or stratified by sex. Prevalence of comorbidities was higher in women and increased among both sexes through the study period. Women had longer LOS and higher in-hospital mortality than men across all age groups. However, observed in-hospital mortality declined significantly for women from 2001 to 2010 (from 3.3% to 2.3%, relative change 30.5%; p for trend < 0.0001), but not for men (from 2% to 1.8%, relative change 8.6%; p for trend = 0.60).
Conclusions:
The authors concluded that AMI hospitalization rates for young people have not declined over the past decade.
Perspective:
This study reports that in contrast to what is occurring in older patients, younger people are not experiencing reductions in AMI hospitalizations. In addition, differences between hospitalization rates of blacks and whites are much more pronounced among young women compared with men. Young women with AMIs have more comorbidity, longer LOS, and higher in-hospital mortality than young men, although their mortality rates are decreasing. The trends in the frequencies of comorbidities have increased for both young women and men hospitalized with AMIs in the past decade, suggesting a greater need for intensive primary prevention efforts in this high-risk population.
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