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Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3913 (Published 07 August 2015) Cite this as: BMJ 2015;351:h3913

Re: Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries

Thank you Dr. Gupta. To investigate the influence of ethnicity on variation of AMI 30-day mortality among the UK hospitals, additional sensitivity analyses were performed.

Ethnicity information was not documented in SWEDEHAEART/RIKS-HIA. In the UK, ethnicity information was available in 214980 (55%) of the patients recorded in MINAP during the study period. 202056 (94%) were white, 1178 (0.6%) were black, and 8697 (4%) were south Asian (Indian, Pakistani, Bangladeshi, and other Asian). The averaged age and other case-mix characteristics were however similar among ethnic groups (Table).

At hospital level, higher proportion of Black patients admitted to the hospital was associated with higher hospital 30-day mortality (-0.32, p<0.001). However, the association became insignificant (-0.077, p=0.26) after adjusting for other case-mix characteristics at hospital level. Similar trend was observed between hospital admission of South Asian patients and hospital 30-day AMI mortality.

Therefore, ethnicity did not add to the existing case-mix adjustment, used in main analyses of the study. Thus, despite the different ethnicity composition, the discrepancy in hospital variation in 30-day AMI mortality remained between the two countries.

Competing interests: No competing interests

17 September 2015
Sheng-Chia Chung
Research Associate
Johan Sundström, Chris P Gale, Adam Timmis, Tomas Jernberg and Harry Hemingway
The Farr Institute of Health Informatics Research / Institute of Health Informatics, University College London
222 Euston Road, London NW1 2DA