By Karen N. Peart
There is a 17% greater risk of dying after a heart attack if you are treated in a hospital located in a U.S. territory - i.e. the U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and Northern Mariana Islands-rather than in a hospital in the mainland United States, according to new findings published in the Archives of Internal Medicine.
The study by Yale School of Medicine researchers shows that many U.S. citizens who call the U.S. territories home, are at a major healthcare disadvantage.
Led by Marcella Nunez-Smith, M.D., assistant professor at Yale School of Medicine, the authors used data from Medicare to study all patients suffering from a heart attack who were admitted to 57 hospitals in the U.S. territories. They compared these to heart attack patients admitted to 4,799 hospitals in the mainland between July 2005 and June 2008. They found that the risk of death within 30 days after a heart attack was substantially higher for patients in all of the U.S. territories.
"We were shocked by these findings," said Nunez-Smith. "These are serious and substantial differences and translate into increased lives lost in the U.S. territories."
Nunez-Smith and her colleagues sought explanations for these findings by exploring whether patients overall just got sicker in the U.S. territories, but found the answer was "no."
"This work does put the spotlight on the need for increased resources in the U.S. territories to improve the quality of care," said Nunez-Smith. "One potential policy area for follow-up would be Medicare reimbursement rates. Hospitals in the U.S. territories have the lowest reimbursement rates of anywhere in the nation. We plan to do follow-up work with hospitals in the U.S. territories and policymakers to identify opportunities to improve health outcomes for people who live, work and play in the U.S territories."
Other Yale authors on the study include Elizabeth H. Bradley, Jeph Herrin, Calie Santana, M.D., Leslie A. Curry, Sharon-Lise T. Normand and Harlan M. Krumholz, M.D.
Nunez-Smith's work was partially funded by the Yale Clinical and Translational Science Award (CTSA) grant from the National Center for Research Resources at the National Institutes of Health.