ABSTRACT
Background
Methods
Results
Conclusions
Key Indexing Terms
INTRODUCTION
METHODS
Data Source and Sampling
Agency for Healthcare Research and Quality (AHRQa). Medical expenditure panel survey. 2014 Full year consolidated data file 2016a, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h171/h171doc.pdf. Accessed August 1, 2019.
Agency for Healthcare Research and Quality (AHRQb). Medical expenditure panel survey, 2014 medical conditions 2016b, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h170/h170doc.pdf. Accessed August 1, 2019.
National Center for Health Statistics. Health, United States, 2009: with special feature on medical technology. Hyattsville, MS. 2010, Available at:https://www.cdc.gov/nchs/data/hus/hus09.pdf. Accessed August 1, 2019.
National Center for Health Statistics. Health, United States, 2009: with special feature on medical technology. Hyattsville, MS. 2010, Available at:https://www.cdc.gov/nchs/data/hus/hus09.pdf. Accessed August 1, 2019.
Measures
Dependent Variables
Direct medical cost
Agency for Healthcare Research and Quality (AHRQa). Medical expenditure panel survey. 2014 Full year consolidated data file 2016a, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h171/h171doc.pdf. Accessed August 1, 2019.
Indirect costs
Agency for Healthcare Research and Quality (AHRQa). Medical expenditure panel survey. 2014 Full year consolidated data file 2016a, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h171/h171doc.pdf. Accessed August 1, 2019.
Independent Variables
Agency for Healthcare Research and Quality (AHRQb). Medical expenditure panel survey, 2014 medical conditions 2016b, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h170/h170doc.pdf. Accessed August 1, 2019.
Agency for Healthcare Research and Quality (AHRQa). Medical expenditure panel survey. 2014 Full year consolidated data file 2016a, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h171/h171doc.pdf. Accessed August 1, 2019.
Mortality Data
Statistical Analyses
Bureau of Labor Statistics, CPI Inflation Calculator. Available at: https://www.bls.gov/data/inflation_calculator.htm. Accessed July 10, 2019.
Agency for Healthcare Research and Quality (AHRQa). Medical expenditure panel survey. 2014 Full year consolidated data file 2016a, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h171/h171doc.pdf. Accessed August 1, 2019.
U.S. Bureau of Economic Analysis, Gross Domestic Product: Implicit Price Deflator [GDPDEF], retrieved from FRED, Federal Reserve Bank of St. Louis, Available at: https://fred.stlouisfed.org/series/GDPDEF. Accessed June 5, 2019.
RESULTS
Variables | AMI (%) | No-AMI (%) | P Value |
---|---|---|---|
N (n) | 4,212,846 (4,769) | 249,022,206 (320,100) | |
Age category | |||
Age <65 | 40.8 | 85.5 | <0.001 |
Age ≥65 | 59.2 | 14.5 | |
Sex | |||
Male | 64.1 | 46.7 | <0.001 |
Female | 35.9 | 53.5 | |
Race/ethnicity | |||
Non-Hispanic White | 80.5 | 68.4 | <0.001 |
Non-Hispanic Black | 9.0 | 11.1 | |
Hispanic | 6.8 | 13.7 | |
Others | 3.7 | 6.8 | |
Marital status | |||
Married | 58.0 | 52.9 | <0.001 |
Non-married | 36.0 | 20.3 | |
Never married | 6.0 | 26.8 | |
Education category | |||
<High school | 9.8 | 19.7 | <0.001 |
High school graduate | 46.2 | 33.9 | |
College or more | 44.0 | 46.4 | |
Insurance | |||
Private | 57.0 | 69.6 | <0.001 |
Public | 38.5 | 20.4 | |
Uninsured | 4.5 | 10.0 | |
Census region | |||
Northeast | 18.4 | 18.2 | <0.001 |
Midwest | 25.4 | 22.6 | |
South | 39.0 | 36.3 | |
West | 17.2 | 22.9 | |
Income category | |||
Poor income | 21.5 | 17.3 | <0.001 |
Low income | 17.7 | 13.4 | |
Middle income | 29.9 | 30.3 | |
High income | 30.9 | 39.0 | |
Charlson Comorbidity Index | |||
0 | 36.2 | 77.0 | <0.001 |
1 | 11.8 | 8.3 | |
≥2 | 52.0 | 14.7 |
Annual Mean Unadjusted Direct and Indirect Costs by AMI Status
Costs | AMI Mean | 95% CI | No-AMI Mean | 95% CI | P Value |
---|---|---|---|---|---|
Direct costs ($) | |||||
Total costs | 18,739 | 17,692-19,787 | 4,822 | 4,735-4,908 | <0.001 |
Inpatient | 8,346 | 7,599-9,093 | 1,259 | 1,212-1,305 | <0.001 |
Outpatient | 4,152 | 3,823-4,482 | 1,667 | 1,634-1,701 | <0.001 |
Medications | 3,976 | 3,737-4,215 | 1,094 | 1,064-1,124 | <0.001 |
Emergency Room | 689 | 601-777 | 192 | 187-198 | <0.001 |
Home Health | 988 | 813-1,164 | 168 | 142-194 | <0.001 |
Others | 585 | 514-656 | 438 | 429-448 | <0.001 |
Indirect costs | |||||
Wage ($) | 25,904 | 23,614-28,195 | 37,060 | 36,489-37,631 | <0.001 |
Missed workdays (n) | 10.8 | 8.70-12.96 | 4.1 | 4.07-4.27 | <0.001 |
Adjusted Excess Direct Medical Expenditure of AMI
Regression c For regressions I-VII, the primary outcome is total, inpatient, outpatient, medication, emergency room, home health and other expenditures, respectively. Each regression controls for age, sex, race/ethnicity, marital status, education, health insurance, census region, income, Charlson Comorbidity Index and time trend (2003/06, 2007/10 and 2011/14). | Variables | Excess Cost | 95% CI | P Value |
---|---|---|---|---|
I | Total cost | |||
No-AMI (Ref.) | – | – | ||
AMI | 7,076 | 6,028–8,125 | <0.001 | |
II | Inpatient | |||
No-AMI (Ref.) | – | – | ||
AMI | 3,636 | 3,048–4,223 | <0.001 | |
III | Outpatient | |||
No-AMI (Ref.) | – | – | ||
AMI | 932 | 713–1,151 | <0.001 | |
IV | Medications | |||
No-AMI (Ref.) | – | – | ||
AMI | 1,072 | 935–1,208 | <0.001 | |
V | Emergency room | |||
No-AMI (Ref.) | – | – | ||
AMI | 395 | 311–478 | <0.001 | |
VI | Home health | |||
No-AMI (Ref.) | – | – | ||
AMI | 179 | 107–252 | <0.001 | |
VII | Others | |||
No-AMI (Ref.) | – | – | ||
AMI | 72 | 14–130 | 0.014 |
Adjusted Indirect Costs of Lost Productivity Attributable to AMI
Regression b For regressions I-III, the primary outcome is wage, missed work days and employed full time, respectively. Each regression controls for age, sex, race/ethnicity, marital status, education, health insurance, census region, income, Charlson Comorbidity Index and time trend (2003/06, 2007/10 and 2011/14). Regression I-reported marginal effect from GLM, family gamma and log link. Regression II- reported the marginal effects from negative binomial model. Regression III-reported odds-ratio from logistic regression model. | Variables | Coefficients | 95% CI | P Value |
---|---|---|---|---|
I | Wage | |||
No-AMI (Ref.) | – | – | ||
AMI | −10,166 | −12,985 to −7,347 | <0.001 | |
II | Missed workdays | |||
No-AMI (Ref.) | – | – | ||
AMI | 5.9 | 3.57-8.27 | <0.001 | |
III | Employed full time | |||
No-AMI (Ref.) | – | – | ||
AMI | 0.54 | 0.469-0.623 | <0.001 |
Age, years | Total deaths 2003-2014 | Present value of one life (2016 $) | Present value of total mortality 2003-2014 (in billion 2016$) |
---|---|---|---|
<1 | 98 | 1,357,715 | 0.133 |
1-4 | 28 | 1,357,715 | 0.038 |
5-14 | 75 | 1,579,220 | 0.118 |
15-24 | 696 | 1,845,536 | 1.284 |
25-34 | 4,718 | 1,808,639 | 8.533 |
35-44 | 27,950 | 1,472,032 | 41.143 |
45-54 | 109,693 | 1,020,564 | 111.948 |
55-64 | 217,717 | 562,298 | 122.421 |
65-74 | 294,079 | 269,317 | 79.200 |
75-84 | 446,694 | 139,338 | 62.241 |
≥85 | 501,178 | 116,753 | 58.514 |
Total | 1,602,926 | - | 485.573 |
U.S. Bureau of Economic Analysis, Gross Domestic Product: Implicit Price Deflator [GDPDEF], retrieved from FRED, Federal Reserve Bank of St. Louis, Available at: https://fred.stlouisfed.org/series/GDPDEF. Accessed June 5, 2019.
Total Aggregate Cost Attributable to AMI

DISCUSSION
The Henry J Kaiser Family Foundation. The uninsured: a primer. Key Facts about Health Insurance on the Eve Health Reform, 2016. Available at:https://kaiserfamilyfoundation.files.wordpress.com/2013/10/7451-09-the-uninsured-a-primer-key-facts-about-health-insurance.pdf. Accessed June 5, 2019.
- Seo H
- Yoon S-J
- Yoon J
- Kim D
- et al.
CONCLUSIONS
AVAILABILITY OF DATA AND MATERIALS
AUTHOR CONTRIBUTIONS
GUARANTORS
REFERENCES
- Acute myocardial infarction.Dis Mon. 2013; 59: 83-96
- Deaths: final data for 2014.Natl Vital Stat Rep. 2016; 65: 1-121
- Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both.Vasc Health Risk Manag. 2015; 11: 25-34
- Acute coronary syndromes: morbidity, mortality and pharmacoeconomic burden.Am J Manag Care. 2009; 15: S36-S41
- National Health Care Spending in 2016: spending and enrollment growth slow after initial coverage expansions.Health Aff (Millwood). 2018; 37: 150-160
- US spending on personal health care and public health, 1996-2013.JAMA. 2016; 316: 2627-2646
- Hospitalization costs for acute myocardial infarction patients treated with percutaneous coronary intervention in the United States are substantially higher than Medicare payments.Clin Cardiol. 2015; 38: 13-19
- The cost of acute myocardial infarction in the new millennium: evidence from a multinational registry.Am Heart J. 2006; 151: 206-212
- Medical expenditures associated with diabetes in myocardial infarction and ischemic stroke patients.Am J Prev Med. 2017; 53 (Supplement 2): S190-S196
Agency for Healthcare Research and Quality (AHRQa). Medical expenditure panel survey. 2014 Full year consolidated data file 2016a, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h171/h171doc.pdf. Accessed August 1, 2019.
Agency for Healthcare Research and Quality (AHRQb). Medical expenditure panel survey, 2014 medical conditions 2016b, Available at:https://meps.ahrq.gov/data_stats/download_data/pufs/h170/h170doc.pdf. Accessed August 1, 2019.
National Center for Health Statistics. Health, United States, 2009: with special feature on medical technology. Hyattsville, MS. 2010, Available at:https://www.cdc.gov/nchs/data/hus/hus09.pdf. Accessed August 1, 2019.
- Economic differences in direct and indirect costs between people with epilepsy and without epilepsy.Med Care. 2012; 50: 928-933
- The association of diabetes with job absenteeism costs among obese and morbidly obese workers.J Occup Environ Med. 2008; 50: 527-534
- Quantifying the incremental and aggregate cost of missed work days in adults with diabetes.J Gen Intern Med. 2015; 30: 1773-1779
- Practical considerations on the use of the Charlson comorbidity index with administrative data bases.J Epidemiol. 1996; 49: 1429-1433
- Estimating log models: to transform or not to transform?.J Health Econ. 2001; 20: 461-494
- Twopm: two-part models.Stata J. 2015; 15: 3-20
- Goodness-of-fit test for a logistic regression model fitted using survey sample data.Stata J. 2006; 6: 97-105
Bureau of Labor Statistics, CPI Inflation Calculator. Available at: https://www.bls.gov/data/inflation_calculator.htm. Accessed July 10, 2019.
- Stata: Release 14. Statistical Software.StataCorp LP, College Station, TX2015
- Economic productivity by age and sex: 2007 estimates for the United States.Med Care. 2009; 47: S94-103
U.S. Bureau of Economic Analysis, Gross Domestic Product: Implicit Price Deflator [GDPDEF], retrieved from FRED, Federal Reserve Bank of St. Louis, Available at: https://fred.stlouisfed.org/series/GDPDEF. Accessed June 5, 2019.
- Deaths: final data for 2003.Natl Vital Stat Rep. 2006; 54: 1-119
- Deaths: final data for 2004.Natl Vital Stat Rep. 2007; 55: 1-119
- Deaths: final data for 2005.Natl Vital Stat Rep. 2008; 56: 1-120
- Deaths: final data for 2006.Natl Vital Stat Rep. 2009; 57: 1-134
- Deaths: final data for 2007.Natl Vital Stat Rep. 2010; 58: 1-134
- Deaths: final data for 2008.Natl Vital Stat Rep. 2011; 59: 1-126
- Deaths: final data for 2009.Natl Vital Stat Rep. 2011; 60: 1-116
- Deaths: final data for 2010.Natl Vital Stat Rep. 2013; 61: 1-117
- Deaths: final data for 2011.Natl Vital Stat Rep. 2015; 63: 1-117
- Deaths: final data for 2012.Natl Vital Stat Rep. 2015; 63: 1-117
- Deaths: final data for 2013.Natl Vital Stat Rep. 2016; 64: 1-118
- Acute stroke intervention: a systematic review.JAMA. 2015; 313: 1451-1462
- Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.Circ Heart Fail. 2013; 6: 606-619
- Acute myocardial infarction.N Engl J Med. 2017; 376: 2053-2064
- Osaka Acute Coronary Insufficiency Study (OACIS) Group. Predictors of length of hospital stay after acute myocardial infarction in Japan.Circ J. 2004; 68: 809-815
- Acute myocardial infarction in elderly patients: comparative analysis of the predictors of mortality. The elderly versus the young.Arq Bras Cardiol. 2002; 79: 363-374
- Acute myocardial infarction hospitalization in the United States, 1979 to 2005.Am J Med. 2010; 123: 259-266
- Temporal trends in the use of antiplatelet therapy in patients with acute coronary syndromes.J Cardiovasc Pharmacol Ther. 2018; 23: 57-65
- Recurrence of acute myocardial infarction in patients discharged on clopidogrel and a proton pump inhibitor after stent placement for acute myocardial infarction.Clin Cardiol. 2010; 33: 168-171
- Prevalence of depression in survivors of acute myocardial infarction.J Gen Intern Med. 2006; 21: 30-38
The Henry J Kaiser Family Foundation. The uninsured: a primer. Key Facts about Health Insurance on the Eve Health Reform, 2016. Available at:https://kaiserfamilyfoundation.files.wordpress.com/2013/10/7451-09-the-uninsured-a-primer-key-facts-about-health-insurance.pdf. Accessed June 5, 2019.
- National Health Care Spending in 2016: spending and enrollment growth slow after initial coverage expansions.Health Aff (Millwood). 2018; 37: 150-160
- Executive summary: heart disease and stroke statistics–2016 update: a report from the American Heart Association.Circulation. 2016; 133: 447-454
- Recent trends in economic burden of acute myocardial infarction in South Korea.PLoS One. 2015; 10e0117446https://doi.org/10.1371/journal.pone.0117446
- The burden of acute myocardial infarction after a regional cardiovascular center project in Korea.Int J Qual Health Care. 2015; 27: 349-355
- Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction.N Engl J Med. 1995; 332: 1418-1424
- Modelling the short term consequences of smoking cessation in England on the hospitalisation rates for acute myocardial infarction and stroke.Tob Control. 2000; 9: 397-400
- Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries.Am Heart J. 2013; 165: 785-792
- Financial barriers to health care and outcomes after acute myocardial infarction.JAMA. 2007; 297: 1063-1072
Article info
Publication history
Footnotes
Disclosures: The authors declare that they have no competing interest.
Sources of funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.