Role of ambulatory care utilization in accounting for higher inpatient acute myocardial infarction mortality among Asian Americans
Kim, Eun Ji
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INTRODUCTION: To address a lack of population-level studies that examine the association between ambulatory care utilization and cardiovascular outcomes among Asian Americans, this study examined 1) ambulatory care utilization among different racial/ethnic groups and 2) the association between ambulatory care utilization and cardiovascular outcomes. METHOD: This was a retrospective analysis of 2009–2012 Medicare fee-for-service data. Primary outcomes were 1) hospitalization for angina, an ambulatory care sensitive condition, and 2) inpatient AMI mortality. Intermediate outcomes of interest were ambulatory care utilization. First, a descriptive analysis of patients’ predisposing and enabling factors was performed, and then bivariate association between these predisposing and enabling factors and ambulatory care utilization was examined. Lastly, using multivariate logistic regression models I estimated the association between ambulatory care utilization and cardiovascular outcomes, adjusting for socio-demographic and geographical characteristics. RESULTS: There were 999,999 people in the analytic sample, drawn from 21.6 million Medicare fee-for-service enrollees. In 2009, there were significant differences in racial/ethnic ambulatory care utilization. Significantly lower percentage of Asians had frequent ambulatory care visits (>30 visits) and outpatient cardiology clinic visits (>30 visits) (both p-values<0.01), after adjusting for predisposing and enabling factors. Asians had the highest observed inpatient mortality (15.9%) and low ambulatory utilization was associated with increased odds (OR=1.85 [1.11–3.08]) of inpatient AMI mortality. CONCLUSION: Among Medicare fee-for-service enrollees, Asians had fewer ambulatory clinic visits. Low ambulatory care utilization was associated with increased odds of AMI mortality. Further research is needed to understand the causal relationship between ambulatory care utilization and cardiovascular outcomes.