Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
Circulation. 2010 Mar 23;121(11):1322-8. doi: 10.1161/CIRCULATIONAHA.109.862094. Epub 2010 Mar 8.
Amid recent efforts to reduce cardiovascular risk, whether rates of acute myocardial infarction (AMI) in the United States have declined for elderly patients is unknown.
Medicare fee-for-service patients hospitalized in the United States with a principal discharge diagnosis of AMI were identified through the use of data from the Centers for Medicare and Medicaid Services from 2002 to 2007, a time period selected to reduce changes arising from the new definition of AMI. The Medicare beneficiary denominator file was used to determine the population at risk. AMI hospitalization rates were calculated annually per 100,000 beneficiary-years with Poisson regression analysis and stratified according to age, sex, and race. The annual AMI hospitalization rate in the fee-for-service Medicare population fell from 1131 per 100,000 beneficiary-years in 2002 to 866 in 2007, a relative 23.4% decline. After adjustment for age, sex, and race, the AMI hospitalization rate declined by 5.8%/y. From 2002 to 2007, white men experienced a 24.4% decrease in AMI hospitalizations, whereas black men experienced a smaller decline (18.0%; P<0.001 for interaction). Black women had a smaller decline in AMI hospitalization rate compared with white women (18.4% versus 23.3%, respectively; P<0.001 for interaction).
AMI hospitalization rates fell markedly in the Medicare fee-for-service population between 2002 and 2007. However, black men and women appeared to have had a slower rate of decline compared with their white counterparts.
在美国，最近为降低心血管风险所做的努力中，老年人的急性心肌梗死（AMI）发生率是否有所下降尚不清楚。
利用美国医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）2002 年至 2007 年的数据，确定了在美国因主要出院诊断为 AMI 而住院的医疗保险按服务项目付费患者。选择这一时间段是为了减少因 AMI 的新定义而产生的变化。利用医疗保险受益人数文件来确定危险人群。用泊松回归分析每年每 10 万受益人数计算 AMI 住院率，并根据年龄、性别和种族分层。2002 年至 2007 年，医疗保险按服务项目付费人群的 AMI 住院率从每年每 10 万受益人数 1131 例降至 866 例，相对下降 23.4%。在调整年龄、性别和种族后，AMI 住院率每年下降 5.8%。2002 年至 2007 年，白人男性 AMI 住院人数下降了 24.4%，而黑人男性的降幅较小（18.0%；交互作用 P<0.001）。与白人女性相比，黑人女性 AMI 住院率的下降幅度较小（分别为 18.4%和 23.3%；交互作用 P<0.001）。
2002 年至 2007 年，医疗保险按服务项目付费人群的 AMI 住院率显著下降。然而，与白人相比，黑人和女性的下降速度似乎较慢。
