mortality from acute coronary syndrome: does place of residence matter?

Background: current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. this study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (acs) to find whether there were differences in the outcome and received treatment. methods: between may 2007 and january 2018, patients admitted with acs were included. the patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. the association between place of residence (rural/ urban) and in-hospital mortality due to acs was evaluated using logistic regression adjusted for potential confounders. results: of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. a positive family history of coronary artery disease (p=0.003), smoking (p=0.002), and hyperlipidemia (p=0.026), as well as a higher body mass index (p=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (p<0.001) and higher unemployment rates (p=0.009). in-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (p=0.465). the firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (or, 1.57; 95% ci, 0.376 to 7.450; p=0.585). conclusion: this study found no significant differences in receiving proper treatment and in-hospital mortality between ru-ral and urban patients with acs.