• H D Vu, R F Heller, L L Lim, C D'Este, and R L O'Connell.
• Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, David Maddison Clinical Sciences Building, Royal Newcastle Hospital, Newcastle NSW 2300, Australia.
• J Epidemiol Community Health. 2000 Aug 1; 54 (8): 590-5.

Study ObjectivesTo compare in-hospital mortality for acute myocardial infarction (AMI) between metropolitan and non-metropolitan hospitals after adjustment for patients' severity; to examine the role of the use of effective cardiac medications in the possible mortality difference between these types of hospital.DesignRetrospective cohort study.Setting47 acute public hospitals in metropolitan and non-metropolitan areas of New South Wales, Australia, taking part in the Acute Cardiac Care Project based on medical record review.Patients1665 patients with principal discharge diagnosis of AMI from February to June 1996.Main ResultsThere was no difference in crude mortality rate (assessed as seven day mortality) between metropolitan and non-metropolitan hospitals (11.0% compared with 10.7% respectively, p=0.893). After adjustment for severity in a logistic regression model, the odds of death in non-metropolitan hospitals was significantly higher than in metropolitan hospitals (odds ratio = 1. 90; 95% CI 1.21, 3.23). The addition of the use of effective cardiac medications to the model resulted in the difference between hospital type becoming non-significant (odds ratio=1.09; 95% CI 0.57, 2.07).ConclusionsIn-hospital mortality in non-metropolitan hospitals was higher than that in metropolitan hospitals, after adjustment for patients' severity. This might partly be explained by the difference in use of effective cardiac medications between hospital type.

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