Geographic Variation in Process and Outcomes of Care for Patients With Acute Myocardial Infarction in China From 2001 to 2015

IMPORTANCE: Variations across regions for managing acute myocardial infarction (AMI) in China are little understood. OBJECTIVE: To evaluate geographic variation and its change with time in treatment process and outcomes for patients with AMI. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Patient-Centered Evaluative Assessment of Cardiac Events–Retrospective AMI project in 2001, 2006, 2011, and 2015 in 153 randomly selected hospitals across China. Patients were hospitalized for AMI. Data were analyzed from October 1 to October 31, 2019. EXPOSURES: Hospitalization in 3 geographic regions (Eastern, Central, and Western) stratified according to China’s official definition. MAIN OUTCOMES AND MEASURES: Process of care measures included reperfusion therapies, aspirin, clopidogrel, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were clinically eligible without contraindications (considered as ideal candidates for treatments). Outcome measures included in-hospital mortality and 5-day mortality. Mixed models were used to assess the regional disparities and time-region interactions in those measures, adjusting for patient characteristics. RESULTS: In 153 hospitals across China, 27 046 patient hospitalizations for AMI were sampled. There was a significant difference across regions in process of care and the odds ratio (OR) of delivering any 1 of the 6 treatments to an ideal patient was 0.83 (95% CI, 0.76-0.91; P < .001) for the lowest region compared with the highest region. The variation between the 2 higher regions narrowed (time-by-Eastern region interaction: OR, 0.83; 95% CI, 0.76-0.91; P < .001). The region with the highest in-hospital mortality had 1.46 times greater in-hospital mortality (95% CI, 1.07-2.00; P < .001) than the lowest region and the region with the highest 5-day mortality had 1.52 times greater 5-day mortality (95% CI, 1.09-2.11; P = .04) than the lowest region. The geographic variation in mortality did not change over time. CONCLUSIONS AND RELEVANCE: In this study, significant geographic variations in process of care and outcomes were found to persist in China; further targeted and region-based approaches to AMI management are warranted.