Bridging the regional gap: declining mortality trends in early onset acute coronary syndrome in low GDP region of China: findings from the Chinese Cardiovascular Association (CCA) database-chest pain
Y Du, W Chen, Y Chen, X Jin, Y Huo, J Ge, H Gong, R HuangAbstract
Background
Early-onset acute coronary syndrome imposes a heavy socioeconomic burden on the younger workforce. Although chest pain centers have expanded across China to standardize care, evidence regarding the interplay between regional economic levels and gender on the prognosis of these young patients remains limited.
Purpose
This study aimed to evaluate temporal trends in age standardized in hospital mortality and investigate the association of regional economic levels and sex with these longitudinal outcomes.
Methods
We conducted a nationwide retrospective cohort study using the Chinese Cardiovascular Association Database Chest Pain Center. The 31 provinces were stratified into High GDP, Middle GDP, and Low GDP regions based on economic data. Weighted Generalized Linear Mixed Models adjusted for patient characteristics and provinces were employed to assess temporal trends in age standardized mortality rates and account for regional heterogeneity
Results
Among 1008673 patients included, the mean age was 47.0 years and 86.7% were male. Low GDP regions accounted for 40.1% of the study population. In the GLMM analysis, mortality rates in High GDP regions remained stable over the study period. Low GDP regions demonstrated a significant downward trend in mortality (Interaction P=0.025). Stratified analyses showed a significant interaction between study year and economic region among male patients (P=0.016), with a specific decline observed in Low GDP regions. For female patients, the interaction between year and economic region was not statistically significant (P>0.05). At the national level, female patients exhibited a continuous decline in age-standardized mortality rate (EAPC: -3.39; 95% CI: -6.49 to -0.19), whereas for male patients, a decreasing trend was specifically observed only in the Low-GDP region (EAPC: -3.27; 95% CI: -5.15 to -1.35).
Conclusion
The mortality decline in low GDP regions confirms the effectiveness of standardized care promoted by Chest Pain Centers. Future health policies should prioritize gender specific care pathways and optimize resource allocation to eliminate these persistent health inequalities.Figure1Figure2