Sex- and race/ethnic differences in short- and long-term mortality after hospitalization for incident acute myocardial infarction.

Background: Acute myocardial infarction (AMI) mortality has declined over the past decade, but sex- and race/ethnic differences remain. We assessed trends in incident AMI mortality stratified by sex and race/ethnicity across separate time periods following hospitalization, which could help target efforts to reduce disparities in care. Method and results: We identified 578,274 Medicare fee-for-service beneficiaries hospitalized with incident AMI from 2008 to 2018 (mean age 80.94, 47.17% men, 86.81% White) and assessed annual mortality for the following periods: in-hospital, post-discharge (0-30 days post-discharge), intermediate-term (31 to 365 days post-discharge), and longer-term (1-3 years post-discharge). Patients who died during one period were not counted in subsequent periods. Risk-adjusted mortality ratios stratified by sex and race/ethnicity were calculated using mixed-effects generalized linear models. The 2008 mortality for men (compared to women) and White patients (compared to Black and Hispanic patients) was considered the baseline. Unadjusted mortality declined across all time periods and for all subgroups from 2008 to 2018. In adjusted analyses, in-hospital and post-discharge mortality was similar for women compared to men and for Black and Hispanic patients compared to White patients. However, women compared to men and Black patients compared to White patients had higher mortality for the intermediate-term and longer-term follow-up periods for all years studied (e.g., 2008 longer-term mortality for men 1.00 (95% CI 0.97-1.02) and for women 1.10 (95% CI 1.06-1.14); 2016 longer-term mortality for men 0.77 (95% CI 0.75-0.8) and for women 0.87 (95% CI 0.84-0.9); 2008 longer-term mortality for White patients 1.00 (95% CI 0.98-1.01) and for Black patients 1.22 (95% CI 1.15-1.30); 2016 longer-term mortality for White patients 0.78 (95% CI 0.70-0.80) and for Black patients 1.03 (95% CI 0.96-1.10)). Conclusions: Incident AMI mortality declined from 2008 to 2018 across all subgroups and follow-up periods. However women and Black patients had persistently higher mortality compared to men and White patients from 31 days to 3 years post-discharge. Opportunities to reduce disparities in AMI care might be particularly effective in longitudinal outpatient care following hospital discharge.