Association between hospital ownership type and ST-segment elevation myocardial infarction outcomes: Insights from the National Readmission Database, 2016-2022.

BACKGROUND

Hospital ownership type may influence acute cardiovascular (CV) disease disparities that persist across the U.S. We examined associations between hospital ownership type and in-hospital and readmission outcomes for ST-elevation myocardial infarction (STEMI) hospitalizations.

METHODS

We performed a retrospective cohort study of hospitalizations for STEMI using the National Readmissions Database (2016-2022). Hospitals were categorized as nonprofit, for-profit, or public. Outcomes included in-hospital mortality and 90-day readmission for acute coronary syndrome, heart failure (HF), CV, and all causes. Associations were assessed using multivariable logistic and Cox proportional hazards regression, adjusting for patient, hospitalization, and hospital-level characteristics.

RESULTS

Of 610,427 STEMI hospitalizations, 460,451 (75.4%) were at nonprofit, 88,965 (14.6%) at for-profit, and 61,011 (10.0%) at public hospitals. Compared with nonprofit hospitals, for-profit hospitals (adjusted odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05-1.13) and public hospitals (aOR 1.17, 95% CI 1.12-1.22) were each associated with higher odds of in-hospital mortality. For-profit hospitals were associated with higher risk of 90-day readmission for acute coronary syndrome (adjusted hazards ratio [HR] 1.15, 95% CI 1.10-1.21), HF (aHR 1.08, 95% CI 1.03-1.13), CV (aHR 1.08, 95% CI 1.05-1.12), and all causes (aHR 1.13, 95% CI 1.10-1.16) relative to nonprofit hospitals. Public hospitals were associated with higher risk of 90-day readmission for HF (aHR 1.08, 95% CI 1.02-1.13) relative to nonprofit hospitals.

CONCLUSIONS

For-profit and public hospitals were associated with higher in-hospital mortality and 90-day readmission for various causes compared with nonprofit hospitals. These findings suggest that hospital-level factors may contribute to disparities in STEMI outcomes and warrant further investigation.