We appreciate Dr Mariotto's interest in our study,1 and we were interested to learn that patients with coronary heart disease in the rural areas of Italy receive more appropriate health care services than those residing in the urban areas. Our study results were based on the aggregate frequency of the use of medications and procedures in 3 groups of hospitals. Consequently, the quality of care provided in a few rural hospitals could have been similar to that in the semirural or urban hospitals. Our study was restricted to elderly patients with acute myocardial infarction admitted to acute care hospitals in the state of Kansas. In support of our findings, we had cited other studies of urban-rural differences in the inpatient care for acute myocardial infarction and other diagnoses in the United States. I agree with Dr Mariotto that our conclusions and recommendations were limited to health care provided in the United States.
Sheikh K. Urban-Rural Differences in the Quality of Care for Medicare Patients With Acute Myocardial Infarction—Reply. Arch Intern Med. 2001;161(19):2386-2387. doi: