The Relationship between Local Economic Conditions and Acute Myocardial Infarction Hospital Utilization by Adults and Seniors in the United States, 1995-2011

Health Serv Res. 2015 Oct;50(5):1688-709. doi: 10.1111/1475-6773.12298. Epub 2015 Mar 15.


Objective: To assess the association between aggregate unemployment and hospital discharges for acute myocardial infarction (AMI) among adults and seniors, 1995-2011.

Data sources/study setting: Community hospital discharge data from states collected for the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and economic data from the Bureau of Labor Statistics, 1995-2011.

Study design: Quarterly time series study of unemployment and aggregate hospital discharges in local areas using fixed effects to control for differences between local areas.

Data collection/extraction methods: Secondary data on inpatient stays and unemployment rates aggregated to micropolitan and metropolitan areas.

Principal findings: For both adults and seniors, a 1 percentage point increase in the contemporaneous unemployment rate was associated with a statistically significant 0.80 percent (adults) to 0.96 percent (seniors) decline in AMI hospitalization during the first half of the study but was unrelated to the economic cycle in the second half of the study period.

Conclusions: The study found evidence that the aggregate relationship between health and the economy may be shifting for cardiovascular events, paralleling recent research that has shown a similar shift for some types of mortality (Ruhm 2013), self-reported health, and inpatient use among seniors (McInerney and Mellor 2012).

Keywords: Acute myocardial infarction; Medicare; determinants of health; economic cycles; hospital utilization.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Female
  • Health Services Research
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Myocardial Infarction / therapy*
  • Patient Discharge / statistics & numerical data*
  • Unemployment / statistics & numerical data*
  • United States