Association of Hospital Racial Composition and Payer Mix With Mortality in Acute Coronary Syndrome

BACKGROUND: Patient characteristics insufficiently explain disparities in cardiovascular outcomes among hospitalized patients, suggesting a role for community or hospital‐level factors. Here, we evaluate the association of hospital racial composition and payer mix with all‐cause inpatient mortality for patients hospitalized with acute coronary syndrome (ACS). METHODS AND RESULTS: Using the National Inpatient Sample, we identified adult hospitalizations from 2014 with a primary diagnosis of ACS (n=550 005). We divided National Inpatient Sample hospitals into quartiles based on percent of minority (black, Hispanic, Asian or Pacific Islander, Native American race/ethnicity) and low‐income payer (Medicaid or uninsured) discharges in 2014. We utilized logistic regression to determine whether hospital minority or low‐income payer makeup associated with all‐cause inpatient mortality among those admitted for ACS . In adjusted models, ACS patients admitted to hospitals with >12.4% to 25.4% (Quartile 2), >25.4% to 44.3% (Q3), and >44.3% (Q4) minority discharges experienced a 14% (OR 1.14, 95% CI 1.06–1.23), 13% (OR 1.13, 95% CI 1.04–1.23), and 15% (OR 1.15, 95% CI 1.04–1.26) increased odds of all‐cause inpatient mortality compared with hospitals with ≤12.4% (Q1) minority discharges. ACS patients admitted to hospitals with >18.7% to 25.7% (Q2) and >34.0% (Q4) low‐income payer discharges experienced a 9% (OR 1.09, 1.01–1.17) and 9% (OR 1.09, 1.00–1.19) increased odds of all‐cause inpatient mortality when compared with hospitals with ≤18.7% (Q1) low‐income payer discharges. CONCLUSIONS: Hospital minority and low‐income payer makeup positively associate with odds of all‐cause inpatient mortality among patients admitted for acute coronary syndrome.