Clinical research study
Disparities in Rates of Acute MI Hospitalization and Coronary Procedures on the US-Mexico Border

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Abstract

Background

Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region.

Methods

Hospital discharge public use data files for 2000 were obtained from the health departments of Arizona, California, and Texas. The diagnosis of acute myocardial infarction was based on International Classification of Diseases-9th Revision, Clinical Modification code 410 as a primary discharge diagnosis. In addition, cardiac catheterization, coronary angioplasty, and bypass grafting procedures were enumerated. Discharges were classified as occurring in hospitals in border counties and nonborder counties.

Results

Overall, 12,464 hospital discharges in border counties had acute myocardial infarction listed as the first diagnosis. Among those aged 45-64 and ≥65 years in border counties, Texas had the lowest discharge rates (eg, at ≥65 years: Texas 95, California 134 per 10,000), lower than in nonborder counties. Among those aged ≥65 years, rates in Texas also were lower in border than nonborder counties, a pattern not seen in other states. On the contrary, rates of catheterization and bypass grafting were highest in Texas, whereas the rates of bypass grafting were actually higher in border than in nonborder counties. In border and nonborder counties of the combined states, hospitalization rates of acute myocardial infarction in Hispanics were lower than those of non-Hispanics. Rates varied little between border and nonborder counties within ethnic groups. A similar pattern was observed for the hospital use of angioplasty and coronary bypass surgery.

Conclusions

Our findings suggest possible underutilization of hospital in-patient care for coronary artery disease by Hispanics who were residents of Texas border counties. Further studies are needed to test this hypothesis using more recent data.

Section snippets

Methods

Public-use data files for hospital discharges were obtained from the health departments of each of 3 of the 4 states on the US-Mexico border (Arizona, California, and Texas).20, 21, 22 New Mexico hospital discharge data were not available in compatible electronic form. Access to these data files and related documentation was gained with the assistance of the state health offices and the US-Mexico Border Health Commission. Details of the methods used were described in a previous report.18

Hospital Discharges for Acute Myocardial Infarction

Overall in 2000, 12,464 hospital discharges in border counties had acute myocardial infarction and 66,950 had any heart disease listed as the first diagnosis (Table). Among those aged 45-64 years in border counties, Arizona had the highest discharge rates and Texas the lowest (Figure 1). The overall US rate was 40 per 10,000 population. Compared with nonborder counties, rates of acute myocardial infarction were lower in Texas border counties but the same in California and Arizona border

Discussion

In order to establish a program for health promotion, the US-Mexico Border Health Commission established the Healthy Border 2010 Program.19 However, there has been a scarcity of data needed for establishing a baseline or performing follow-up assessments of health indicators for morbidity related to coronary heart disease.13 The aim of our work was to provide baseline data on morbidity from acute myocardial infarction in the US-Mexico border area by analyzing hospital discharge data. Further, we

Acknowledgment

The authors would like to acknowledge the assistance of the staff of the state health departments of Arizona, California, and Texas, and the United-States Mexico Border Health Commission.

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    • Funding: None.

    Conflict of Interest: The authors had no conflicts of interest. One author (JSA) received honoraria of <$5000 for consulting not related to this work from Sanofi-Aventis, Merck, Bristol-Myers-Squibb, Pfizer, Astra-Zeneca, McNeill, Organon, Berlex, Novartis, Ciba-Geigy, Exeter CME, and the North American Center for Continuing Medical Education.

    Authorship: All authors had access to the data and a role in writing the manuscript.

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