AHRQ Study: Rising Local Unemployment No Longer Linked to Declining Heart Attack Hospitalizations

An AHRQ study found new evidence that the overall relationship between health and the economy may have shifted over time for cardiovascular events. The study, which used AHRQ’s Healthcare Cost and Utilization Project State Inpatient Databases and Bureau of Labor Statistics data from 1995 to 2011, found that a one percentage point increase in the unemployment rate during that period was associated with a statistically significant 0.80 percent decline in heart attack hospitalizations for adults ages 20 to 64 and a 0.96 percent decline for those ages 65 and older from 1995 to 2003, but not for the second half of the study. Researchers speculated that this shift could be the result of many factors, including structural changes to the health care system, workplaces that seek to enhance the well-being of employees and increased housing costs that add to the burden of the unemployed. The study, “The Relationship between Local Economic Conditions and Acute Myocardial Infarction Hospital Utilization by Adults and Seniors in the United States 1995–2011,” and abstract were published online March 15 in the journal Health Services Research.

2015 Mar 15. doi: 10.1111/1475-6773.12298. [Epub ahead of print]

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

Carls GS1, Henke RM, Karaca Z, Marder WD, Wong HS.

Author information

Abstract

OBJECTIVE:

To assess the association between aggregate unemployment and hospital discharges for acute myocardial infarction (AMI) amongadults 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).