Exploration of Systemic Determinants of In-Hospital Mortality due to Acute Myocardial Infarction in Mexico
Name: Julian Maldonado
School: Vagelos College of Physicians and Surgeons, Class of 2026; Varmus Global Scholar 2023
Mentors: Ariel Pablos-Mendez, MD, MPH and Andrew Moran, MD, MPH
Abstract
Research Question: What are the systemic factors influencing in-hospital mortality due to acute myocardial infarction (AMI)? The exploratory analysis investigates how social and institutional factors impact AMI mortality.
Background: AMI remains a major global health challenge, due to its prevalence, resource requirements and treatment window. Mexico has a concerningly high AMI mortality rate relative to other countries. Healthcare dynamics and socioeconomic disparities play an important role in outcomes.
Methods: The study employs a retrospective cohort analysis using anonymized administrative public data from the Mexican National System for Basic Health Information collected from all public hospital discharges in the country between January 1st, 2018 and December 31st, 2022. Data is cleaned and analyzed in RStudio via stepwise logistic regression.
Results: Overall mortality due to AMI in public hospitals during the timeframe was 21.21%, with 2020 and 2021 as the deadliest 2 years with mortality rates of 22.96% and 21.97% respectively. Discharged associated with AMI mortality had higher rates of diabetes and hypertension than total discharges (33% vs. 5%). Total in-hospital mortality increased among the uninsured poorest tertile of the country from 1.8% to 1.99% post-replacement of Seguro Popular. Multivariate logistic regression analysis reflected 3% increase in AMI mortality per year of age, a 1.46 odds ratio for male sex. Patients with diabetes had an odds ratio of 1.53 but not those with hypertension.
Conclusions: This preliminary inquiry prompts improved data collection in the health sector and healthcare reform to protect Mexico’s vulnerable populations.