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KMID : 1138720190450030059
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Korean Public Health Research
2019 Volume.45 No. 3 p.59 ~ p.68
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A Multilevel Analysis of mortality-related factors in patients with acute myocardial infarction with coronary stenting
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Choi Bo-Young
Lee Hae-Jong
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Abstract
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Purpose: This study aims to analyze the mortality-related factors of patients with acute myocardial infarction who underwent coronary artery stenting according to personal and medical institution characteristics.
Methods: The data was collected from Korean National Health Insurance Service(KNHIS)'s customized database in 2015. χ2-tests, t-tests and multilevel logistic regression analyses were performed.
Results: The hospital mortality rate was 7.6%, and the mortality rate of within 30 days after discharge was 10.3%. The intraclass correlation coefficient(ICC) for hospital mortality was 6.14% and that of mortality within 30 days after discharge(30 days mortality) was 5.98%. The odds ratios(ORs) of hospital deaths increased by 3.14 times at 60-69 years and 8.83 times at ≥70 years compared to at ≤49 years. The ORs decreased by 32.0% at the high income level, 29.0% at the Charlson’s comorbidity index(CCI) 1-2, 49.0% at the CCI 3-4, and 56.0% at the CCI ≥5 compared to at the CCI 0. The OR increased by 1.65 times at Internal Herfindahl Index(IHI) 3rdquartile(Q3) compared to 1stquartile(Q1). The ORs of 30 days mortality increased by 2.85 times at 60-69 years and 8.83 times at ≥70 years. The ORs decreased by 26.0% at the high income level, 44.0% at the CCI 3-4, and 40.0% at the CCI ≥5. The OR increased by 1.55 times at IHI Q3.
Conclusion: The results of the study showed that the variation in the hospital level was very small compared to that in the patient level. Therefore, it’s important to implement applicable policies according to the patient level in order to improve the outcome of AMI patients.
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KEYWORD
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Acute myocardial infarction, Coronary stenting, Mortality, Multilevel Analysis, Korean National Health Insurance Service's customized database
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