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
Date
2009-12-14
Authors
Korda, Rosemary
Clements, Mark S.
Kelman, Christopher William
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BioMed Central Ltd
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.
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Keywords
Keywords: angina pectoris; angiocardiography; article; Australia; comparative study; coronary artery bypass graft; coronary artery disease; female; health care disparity; heart infarction; human; insurance; male; public health; sex difference; socioeconomics; stati
Citation
BMC Public Health 9.460 (2009)
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BMC Public Health
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Journal article
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