ArticleBMC public health2026
Impact of regional STEMI network on rural-urban inequality of ischemic times in Southwest China: a real world longitudinal cohort study : Names of Authors.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundST-elevation myocardial infarction (STEMI) is a life-threatening and time-critical heart disease, and achieving equality in its management remains a major challenge. Rural-urban inequality has been previously identified as major driver of health inequality in STEMI management. How to effectively eliminate the rural-urban inequality of STEMI care remains a huge challenge.
methodThe study aims to evaluate the impact of the regional Network on rural-urban inequality of STEMI care in study setting. A new prefecture-wide STEMI Network was implemented in Chuxiong, an underdeveloped area of Southwest China. A longitudinal study including 5-years STEMI patients from real world and covering the three Network phases (Pre-network, Creation and Post-network phases) was conducted. Outcomes included various intervals of ischemic time, length of hospital stay and in-hospital charge. The total effects of the Network on STEMI care continuous outcomes were estimated using interaction Cox regression models.
resultsA total of 1436 patients were included in the study (285 rural and 95 urban cases during pre-network phase, 209 rural and 166 urban cases during creation phase, 397 rural and 284 urban cases during the post-network phase). After conditioning, significant reduction of rural-urban difference were found after network implementation: the rural-urban differences of patient delay with HR 1.00 [0.86, 1.17] in post-network phase compared with HR 0.50 [0.40, 0.64] in pre-network phase was no longer evident after the network; the rural-urban differences of total ischemic time with HR 0.92 [0.76, 1.11] in post-network phase compared with HR 0.45 [0.33, 0.61] in pre-network phase was no longer evident after the network. Following the network, narrowed rural-urban difference were found in system delay and reperfusion delay, but widened rural-urban difference were found in hospital stays.
conclusionsThe effectiveness of regional Network on reduction health inequality in STEMI care was evident in an under-developed area. It is suggested that the regional STEMI network could focus on promoting reperfusion by fibrinolysis not only in rural area but also in sub-urban area.
trial registrationThe study has been registered in Chinese Clinical Trial Registry (ChiCTR1900026935|| http://www.chictr.org.cn/ ) on October 26, 2019.
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