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Cardiovascular Hospitalizations Among Older Adults in the US and Denmark
Frederikke Held Berg1,2,3, Mats C Højbjerg Lassen2,3,4, Muthiah Vaduganathan4
1Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Insights
The US has higher cardiovascular hospitalization rates than Denmark, particularly for heart attack and heart failure. Income disparities in cardiovascular events are significantly larger in the US compared to Denmark.
Area of Science:
- Public Health
- Cardiology
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a leading cause of death in the US.
- International comparisons of CVD burden are limited, especially across different healthcare systems.
- Understanding income-related disparities in CVD is crucial for targeted interventions.
Purpose of the Study:
- To compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke) and associated outcomes among adults 65 years or older between the US and Denmark.
- To analyze these rates overall and by income level.
- To assess 30-day all-cause mortality following hospitalization for cardiovascular events.
Main Methods:
- Population-based cross-sectional study utilizing national data from the US (Medicare beneficiaries) and Denmark.
- Study period: January 1, 2021, to January 1, 2022.
- Primary outcomes: Age- and sex-standardized hospitalization rates for MI, HF, ischemic stroke, and 30-day all-cause mortality.
Main Results:
- The US had significantly higher age- and sex-standardized cardiovascular hospitalization rates (RR, 1.50) and 30-day mortality (RR, 1.12) compared to Denmark.
- Higher hospitalization risks in the US were observed for MI (RR, 1.56) and HF (RR, 2.37), while ischemic stroke hospitalizations were lower (RR, 0.90).
- Overall cardiovascular hospitalization rates were more than twofold higher in US low-income adults vs. higher-income adults (RR, 2.38), with smaller disparities in Denmark (RR, 1.45).
Conclusions:
- Cardiovascular hospitalization rates are substantially higher in the US compared to Denmark.
- Significant income-based disparities in cardiovascular hospitalizations exist in both countries, but are markedly greater in the US.
- These findings highlight the need for targeted strategies to address CVD burden and income-related inequities in healthcare.
Importance:
Cardiovascular disease is the leading cause of death in the US. However, it remains unclear how the burden of cardiovascular events in the US compares with that of other high-income countries with distinct health care systems like Denmark, both overall and by income.
Objective:
To compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke) and associated outcomes among adults 65 years or older, overall and by income, between the US and Denmark.
Design, Setting, And Participants:
This population-based cross-sectional study used national data from the US and Denmark from January 1, 2021, to January 1, 2022. The study population included all Medicare beneficiaries 65 years or older in the US and all adults 65 years or older in Denmark.
Main Outcomes And Measures:
The primary outcome was age- and sex-standardized hospitalization rates for MI, HF, and ischemic stroke, as well as 30-day all-cause mortality rates.
Results:
The US study population included 58 614 110 adults 65 years or older (mean [SE] age, 74.6 [7.7] years; 32 179 146 female [54.9%]) of whom 1 171 058 (2.0%) were hospitalized for a cardiovascular event. The Danish study population included 1 176 542 adults 65 years or older (mean [SE] age, 75.3 [7.1] years; 634 217 female [53.9%]) of whom 16 305 (1.4%) were hospitalized with a cardiovascular event. The overall age- and sex-standardized cardiovascular hospitalization rate was significantly higher in the US compared with Denmark (risk ratio [RR], 1.50; 95% CI, 1.47-1.52), as were associated 30-day all-cause mortality rates (RR, 1.12; 95% CI, 1.06-1.17). Across conditions, the risk of hospitalization for MI (RR, 1.56; 95% CI, 1.51-1.61) and HF (RR, 2.37; 95% CI, 2.31-2.43) was significantly higher in the US compared with Denmark, whereas hospitalizations for ischemic stroke were lower (RR, 0.90; 95% CI, 0.88-0.93). Overall cardiovascular hospitalization rates in the US were more than 2-fold higher among low-income adults compared with higher-income adults (RR, 2.38; 95% CI, 2.25-2.47), whereas the magnitude of income-based disparities was smaller in Denmark (RR, 1.45; 95% CI, 1.39-1.50).
Conclusions And Relevance:
In this international cross-sectional study, cardiovascular hospitalization rates were significantly higher in the US compared with Denmark. There were income-based differences in the burden of cardiovascular hospitalizations in both countries, although the magnitude of these disparities was much greater in the US.
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