TITLE

Universal health care no guarantee of equity: Comparison of socioeconomic inequalities in the receipt of coronary procedures in patients with acute myocardial infarction and angina

AUTHOR(S)
Korda, Rosemary J.; Clements, Mark S.; Kelman, Chris W.
PUB. DATE
January 2009
SOURCE
BMC Public Health;2009, Vol. 9, p460
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: In Australia there is a socioeconomic gradient in morbidity and mortality favouring socioeconomically advantaged people, much of which is accounted for by ischaemic heart disease. This study examines if Australia's universal health care system, with its mixed public/private funding and delivery model, may actually perpetuate this inequity. We do this by quantifying and comparing socioeconomic inequalities in the receipt of coronary procedures in patients with acute myocardial infarction (AMI) and patients with angina. Methods: Using linked hospital and mortality data, we followed patients admitted to Western Australian hospitals with a first admission for AMI (n = 5539) or angina (n = 7401) in 2001-2003. An outcome event was the receipt, within a year, of a coronary procedure—angiography, angioplasty and/or coronary artery bypass surgery (CABG). Socioeconomic status was assigned to each individual using an area-based measure, the SEIFA Index of Disadvantage. Multivariable proportional hazards regression was used to model the association between socioeconomic status and procedure rates, allowing for censoring and adjustment of multiple covariates. Mediating models examined the effect of private health insurance. Results: In the AMI patient cohort, socioeconomic gradients were not evident except that disadvantaged women were more likely than advantaged women to undergo CABG. In contrast, in the angina patient group there were clear socioeconomic gradients for all procedures, favouring more advantaged patients. Compared with patients in the most disadvantaged quintile of socioeconomic status, patients in the least disadvantaged quintile were 11% (1-21%) more likely to receive angiography, 52% (29-80%) more likely to undergo angioplasty and 30% (3-55%) more likely to undergo CABG. Private health insurance explained some of the socioeconomic variation in rates. Conclusions: Australia's universal health care system does not guarantee equity in the receipt of high technology health care for patients with ischaemic heart disease. While such a system might ensure equity for patients with AMI, where guidelines for treatment are relatively well established, this is not the case for angina patients, where health care may be less urgent and more discretionary.
ACCESSION #
48253012

 

Related Articles

  • GP Registrar Update: CHD prevention - part three. Newson, Louise // GP: General Practitioner;8/9/2004, p34 

    One of the biggest barriers for implementing evidence-based practice may be convincing patients that they need lifelong prevention from coronary heart diseases. Patients often perceive a heart attack to be an acute, self-limiting condition rather than the onset of a high-risk chronic disease. A...

  • Economic evaluation of the impact of nicorandil in angina (IONA) trial. Walker, A.; McMurray, J.; Stewart, S.; Berger, W.; McMahon, A. D.; Dargie, H.; Fox, K.; Hillis, S.; Henderson, N. J. K.; Ford, I. // Heart;May2006, Vol. 92 Issue 5, p619 

    Objective: To estimate the net cost of adding nicorandil to usual treatment for patients with angina and to compare this with indicators of health benefit. Design: Cost effectiveness analysis Setting: Based on results of the IONA (impact of nicorandil on angina) trial. Patients: Patients with...

  • Association Between Angina and Treatment Satisfaction after Myocardial Infarction. Plomondon, Mary E.; Magid, David J.; Masoudi, Frederick A.; Jones, Philip G.; Barry, Lisa C.; Havranek, Edward; Peterson, Eric D.; Krumholz, Harlan M.; Spertus, John A.; Rumsfeld, John S. // JGIM: Journal of General Internal Medicine;Jan2008, Vol. 23 Issue 1, p1 

    Patient satisfaction is increasingly recognized as a quality indicator and important outcome of care. Little is known about the clinical factors associated with satisfaction after myocardial infarction (MI). To assess the hypothesis that angina after MI is independently associated with lower...

  • Economic Evaluation of Enoxaparin Sodium versus Heparin in Unstable Angina: A French Sub-Study of the ESSENCE Trial. detournay, B.; Huet, X.; Fagnani, F.; Montalescot, G. // PharmacoEconomics;2000, Vol. 18 Issue 1, p83 

    Objectives: To perform an evaluation from the societal perspective of the cost of treatment with enoxaparin sodium versus unfractionated heparin (UFH) in patients with unstable angina and non-Q wave myocardial infarction in France. Design: Four complementary cost-minimisation analyses based on...

  • Acute Coronary Syndromes without ST-Segment Elevation – What Is the Role of Early Intervention? Boden, William E. // New England Journal of Medicine;9/15/2005, Vol. 353 Issue 11, p1159 

    The article discusses the significance of early invasive strategy in the treatment of acute coronary syndromes without ST-segment elevation. Early invasive strategy is superior to the selectively invasive strategy in reducing myocardial infarction, severe angina, and rehospitalization during...

  • Prognosis of Women With Newly Diagnosed Coronary Heart Disease--A Comparison With Course of Disease Among Men. Weinblatt, Eve; Shapiro, Sam; Frank, Charles W. // American Journal of Public Health;Jul1973, Vol. 63 Issue 7, p577 

    The article focuses on a medical research that deals with the diagnosis of coronary heart disease in women under 65 at the time of a first myocardial infarction (MI) or diagnosis of angina without previous infarction. The incidences of coronary heart disease (CHD) among women are relatively low...

  • Gender Bias in the Clinical Management of Women with Angina: Another Look at the Yentl Syndrome. Crilly, Michael A.; Bundred, Peter E.; Leckey, Lisa C.; Johnstone, Fiona C. // Journal of Women's Health (15409996);Apr2008, Vol. 17 Issue 3, p331 

    Background: Woman with heart disease may receive lower levels of clinical care than men. We assessed whether the Yentl syndrome (women receive equivalent care to men only when they demonstrate that they are like men by having a heart attack) operates in the management of angina pectoris in...

  • Continuing Education. Mooney, Mary; Browne, Lisa // World of Irish Nursing & Midwifery;Mar2005, Vol. 13 Issue 3, p35 

    The article examines specific management of patients with acute coronary syndromes who present with unstable angina or myocardial infarction without ST elevation on electrocardiogram (NSTEMI). The factors to be considered in the management of patients with NSTEMI includes the initial assessment,...

  • The Giant Cretaceous Coelacanth (Actinistia, Sarcopterygii) Megalocoelacanthus dobiei Schwimmer, Stewart & Williams, 1994, and Its Bearing on Latimerioidei Interrelationships. Dutel, Hugo; Maisey, John G.; Schwimmer, David R.; Janvier, Philippe; Herbin, Marc; Clément, Gaël // PLoS ONE;Nov2012, Vol. 7 Issue 11, Special section p1 

    We present a redescription of Megalocoelacanthus dobiei, a giant fossil coelacanth from Upper Cretaceous strata of North America. Megalocoelacanthus has been previously described on the basis of composite material that consisted of isolated elements. Consequently, many aspects of its anatomy...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics