Disparities in rates of acute MI hospitalization and coronary procedures on the US-Mexico border.

BACKGROUND: Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region. METHODS: Hospital discharge public use data files for 2000 were obtained from the health departments of Arizona, California, and Texas. The diagnosis of acute myocardial infarction was based on International Classification of Diseases-9th Revision, Clinical Modification code 410 as a primary discharge diagnosis. In addition, cardiac catheterization, coronary angioplasty, and bypass grafting procedures were enumerated. Discharges were classified as occurring in hospitals in border counties and nonborder counties. RESULTS: Overall, 12,464 hospital discharges in border counties had acute myocardial infarction listed as the first diagnosis. Among those aged 45-64 and >or=65 years in border counties, Texas had the lowest discharge rates (eg, at >or=65 years: Texas 95, California 134 per 10,000), lower than in nonborder counties. Among those aged >or=65 years, rates in Texas also were lower in border than nonborder counties, a pattern not seen in other states. On the contrary, rates of catheterization and bypass grafting were highest in Texas, whereas the rates of bypass grafting were actually higher in border than in nonborder counties. In border and nonborder counties of the combined states, hospitalization rates of acute myocardial infarction in Hispanics were lower than those of non-Hispanics. Rates varied little between border and nonborder counties within ethnic groups. A similar pattern was observed for the hospital use of angioplasty and coronary bypass surgery. CONCLUSIONS: Our findings suggest possible underutilization of hospital in-patient care for coronary artery disease by Hispanics who were residents of Texas border counties. Further studies are needed to test this hypothesis using more recent data.

Diabetes hospitalization at the U.S.-Mexico border.

INTRODUCTION: The diabetes hospitalization rate for the region along the U.S. side of the U.S.-Mexico border is unknown, a situation that could limit the success of the Healthy Border 2010 program. To remedy this problem, we analyzed and compared hospital discharge data for Arizona, California, and Texas for the year 2000 and calculated the diabetes hospitalization rates. METHODS: We obtained hospital-discharge public-use data files from the health departments of three U.S. border states and looked for cases of diabetes. Only when diabetes was listed as the first diagnosis on the discharge record was it considered a case of diabetes for our study. Patients with cases of diabetes were classified as border county (BC) or nonborder county (NBC) residents. Comparisons between age-adjusted diabetes discharge rates were made using the z test. RESULTS: Overall, 1.2% (86,198) of the discharge records had diabetes listed as the primary diagnosis. BC residents had a significantly higher age-adjusted diabetes discharge rate than NBC residents. BC males had higher diabetes discharge rates than BC females or NBC males. In both the BCs and the NBCs, Hispanics had higher age-adjusted diabetes discharge rates than non-Hispanics. CONCLUSION: The results of this study provide a benchmark against which the effectiveness of the Healthy Border 2010 program can be measured.