Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
Dovestr. 11, 10587, Berlin, Germany.
BMC Health Serv Res. 2024 May 7;24(1):593. doi: 10.1186/s12913-024-11044-6.
In-hospital mortality from acute myocardial infarction (AMI) is widely used in international comparisons as an indicator of health system performance. Because of the high risk of early death after AMI, international comparisons may be biased by differences in the recording of early death cases in hospital inpatient data. This study examined whether differences in the recording of early deaths affect international comparisons of AMI in-hospital mortality by using the example of Germany and the United States, and explored approaches to address this issue.
The German Diagnosis-Related Groups Statistics (DRG Statistics), the U.S. National Inpatient Sample (NIS) and the U.S. Nationwide Emergency Department Sample (NEDS) were analysed from 2014 to 2019. Cases with treatment for AMI were identified in German and U.S. inpatient data. AMI deaths occurring in the emergency department (ED) without inpatient admission were extracted from NEDS data. 30-day in-hospital mortality figures were calculated according to the OECD indicator definition (unlinked data) and modified by including ED deaths, or excluding all same-day cases.
German age-and-sex standardized 30-day in-hospital mortality was substantially higher compared to the U.S. (in 2019, 7.3% vs. 4.6%). The ratio of German vs. U.S. mortality was 1.6. After inclusion of ED deaths in U.S. data this ratio declined to 1.4. Exclusion of same-day cases in German and U.S. data led to a similar ratio.
While short-duration treatments due to early death are generally recorded in German inpatient data, in U.S. inpatient data those cases are partially missing. Excluding cases with short-duration treatment from the calculation of mortality indicators could be a feasible approach to account for differences in the recording of early deaths, that might be existent in other countries as well.
急性心肌梗死（AMI）的院内死亡率被广泛用于国际比较，作为卫生系统绩效的指标。由于 AMI 后早期死亡的风险较高，国际比较可能因医院住院数据中早期死亡病例的记录差异而存在偏差。本研究以德国和美国为例，探讨了早期死亡记录差异是否会影响 AMI 院内死亡率的国际比较，并探讨了解决这一问题的方法。
分析了 2014 年至 2019 年德国诊断相关组统计（DRG 统计）、美国国家住院患者样本（NIS）和美国全国急诊部样本（NEDS）。在德国和美国住院患者数据中识别出 AMI 的治疗病例。从 NEDS 数据中提取在急诊科（ED）发生但未住院的 AMI 死亡病例。根据经合组织指标定义（无关联数据）计算 30 天院内死亡率，方法是纳入 ED 死亡病例，或排除所有同日病例。
德国按年龄和性别标准化的 30 天院内死亡率明显高于美国（2019 年分别为 7.3%和 4.6%）。德国与美国死亡率的比值为 1.6。在美国数据中纳入 ED 死亡病例后，该比值下降至 1.4。排除德国和美国数据中同日病例后，比值相近。
由于德国住院数据中一般会记录因早期死亡而导致的短期治疗，但美国住院数据中部分病例缺失。从死亡率指标的计算中排除短期治疗的病例，可能是一种可行的方法，可以解决其他国家可能存在的早期死亡记录差异问题。
