Berg Frederikke Held, Lassen Mats C Højbjerg, Vaduganathan Muthiah, Fonarow Gregg C, Yeh Robert W, Zheng ZhaoNian, Gislason Gunnar H, Biering-Sørensen Tor, Wadhera Rishi K
Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, University of Copenhagen, Copenhagen, Denmark.
JAMA Cardiol. 2025 Apr 1;10(4):351-358. doi: 10.1001/jamacardio.2024.5303.
Cardiovascular disease is the leading cause of death in the US. However, it remains unclear how the burden of cardiovascular events in the US compares with that of other high-income countries with distinct health care systems like Denmark, both overall and by income.
To compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke) and associated outcomes among adults 65 years or older, overall and by income, between the US and Denmark.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used national data from the US and Denmark from January 1, 2021, to January 1, 2022. The study population included all Medicare beneficiaries 65 years or older in the US and all adults 65 years or older in Denmark.
The primary outcome was age- and sex-standardized hospitalization rates for MI, HF, and ischemic stroke, as well as 30-day all-cause mortality rates.
The US study population included 58 614 110 adults 65 years or older (mean [SE] age, 74.6 [7.7] years; 32 179 146 female [54.9%]) of whom 1 171 058 (2.0%) were hospitalized for a cardiovascular event. The Danish study population included 1 176 542 adults 65 years or older (mean [SE] age, 75.3 [7.1] years; 634 217 female [53.9%]) of whom 16 305 (1.4%) were hospitalized with a cardiovascular event. The overall age- and sex-standardized cardiovascular hospitalization rate was significantly higher in the US compared with Denmark (risk ratio [RR], 1.50; 95% CI, 1.47-1.52), as were associated 30-day all-cause mortality rates (RR, 1.12; 95% CI, 1.06-1.17). Across conditions, the risk of hospitalization for MI (RR, 1.56; 95% CI, 1.51-1.61) and HF (RR, 2.37; 95% CI, 2.31-2.43) was significantly higher in the US compared with Denmark, whereas hospitalizations for ischemic stroke were lower (RR, 0.90; 95% CI, 0.88-0.93). Overall cardiovascular hospitalization rates in the US were more than 2-fold higher among low-income adults compared with higher-income adults (RR, 2.38; 95% CI, 2.25-2.47), whereas the magnitude of income-based disparities was smaller in Denmark (RR, 1.45; 95% CI, 1.39-1.50).
In this international cross-sectional study, cardiovascular hospitalization rates were significantly higher in the US compared with Denmark. There were income-based differences in the burden of cardiovascular hospitalizations in both countries, although the magnitude of these disparities was much greater in the US.
心血管疾病是美国的主要死因。然而，美国心血管事件的负担与丹麦等拥有不同医疗保健系统的其他高收入国家相比如何，总体情况以及按收入划分的情况仍不清楚。
比较美国和丹麦65岁及以上成年人中心血管疾病住院率（急性心肌梗死[MI]、心力衰竭[HF]、缺血性中风）及相关结局，总体情况以及按收入划分的情况。
设计、设置和参与者：这项基于人群的横断面研究使用了2021年1月1日至2022年1月1日期间美国和丹麦的国家数据。研究人群包括美国所有65岁及以上的医疗保险受益人以及丹麦所有65岁及以上的成年人。
主要结局是MI、HF和缺血性中风的年龄和性别标准化住院率，以及30天全因死亡率。
美国研究人群包括58614110名65岁及以上成年人（平均[标准差]年龄，74.6[7.7]岁；32179146名女性[54.9%]），其中1171058人（2.0%）因心血管事件住院。丹麦研究人群包括1176542名65岁及以上成年人（平均[标准差]年龄，75.3[7.1]岁；634217名女性[53.9%]），其中16305人（1.4%）因心血管事件住院。与丹麦相比，美国总体年龄和性别标准化心血管住院率显著更高（风险比[RR]，1.50；95%置信区间，1.47 - 1.52），30天全因死亡率也是如此（RR，1.12；95%置信区间，1.06 - 1.17）。在各种疾病中，与丹麦相比，美国MI（RR，1.56；95%置信区间，1.51 - 1.61）和HF（RR，2.37；95%置信区间，2.31 - 2.43）的住院风险显著更高，而缺血性中风的住院率较低（RR，0.90；95%置信区间，0.88 - 0.93）。美国低收入成年人的总体心血管住院率比高收入成年人高出2倍多（RR，2.38；95%置信区间，2.25 - 2.47），而丹麦基于收入的差异幅度较小（RR，1.45；95%置信区间，1.39 - 1.50）。
在这项国际横断面研究中，与丹麦相比，美国的心血管住院率显著更高。两国心血管住院负担均存在基于收入的差异，尽管美国这些差异的幅度要大得多。
