Education-related variation in coronary procedure rates and the contribution of private health care in Australia: a prospective cohort study

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dc.contributor.authorHughes, Veronica
dc.contributor.authorPaige, Ellie
dc.contributor.authorWelsh, Jennifer
dc.contributor.authorJoshy, Grace
dc.contributor.authorBanks, Emily
dc.contributor.authorKorda, Rosemary
dc.date.accessioned2021-02-11T00:52:03Z
dc.date.available2021-02-11T00:52:03Z
dc.date.issued2020
dc.date.updated2020-11-08T07:19:31Z
dc.description.abstractBackground Contemporary Australian evidence on socioeconomic variation in secondary cardiovascular disease (CVD) care, a possible contributor to inequalities in cardiovascular disease outcomes, is lacking. This study examined the relationship between education, an individual-level indicator of socioeconomic position, and receipt of angiography and revascularisation procedures following incident hospitalisation for acute myocardial infarction (AMI) or angina, and the role of private care in this relationship. Methods Participants aged ≥45 from the New South Wales population-based 45 and Up Study with no history of prior ischaemic heart disease hospitalised for AMI or angina were followed for receipt of angiography or revascularisation within 30 days of hospital admission, ascertained through linked hospital records. Education attainment, measured on baseline survey, was categorised as low (no school certificate/qualifications), intermediate (school certificate/trade/apprenticeship/diploma) and high (university degree). Cox regression estimated the association (hazard ratios [HRs]) between education and coronary procedure receipt, adjusting for demographic and health-related factors, and testing for linear trend. Private health insurance was investigated as a mediating variable. Results Among 4454 patients with AMI, 68.3% received angiography within 30 days of admission (crude rate: 25.8/person-year) and 48.8% received revascularisation (rate: 11.7/person-year); corresponding figures among 4348 angina patients were 59.7% (rate: 17.4/person-year) and 30.8% (rate: 5.3/person-year). Procedure rates decreased with decreasing levels of education. Comparing low to high education, angiography rates were 29% lower among AMI patients (adjusted HR = 0.71, 95% CI: 0.56–0.90) and 40% lower among angina patients (0.60, 0.47–0.76). Patterns were similar for revascularisation among those with angina (0.78, 0.61–0.99) but not AMI (0.93, 0.69–1.25). After adjustment for private health insurance status, the HRs were attenuated and there was little evidence of an association between education and angiography among those admitted for AMI. Conclusions There is a socioeconomic gradient in coronary procedures with the most disadvantaged patients being less likely to receive angiography following hospital admission for AMI or angina, and revascularisation procedures for angina. Unequal access to private health care contributes to these differences. The extent to which the remaining variation is clinically appropriate, or whether angiography is being underused among people with low socioeconomic position or overused among those with higher socioeconomic position, is unclear.en_AU
dc.description.sponsorshipEllie Paige was supported by a Postdoctoral Fellowship (reference: 102131) from the National Heart Foundation of Australiaen_AU
dc.format.mimetypeapplication/pdfen_AU
dc.identifier.issn1475-9276en_AU
dc.identifier.urihttp://hdl.handle.net/1885/222458
dc.language.isoen_AUen_AU
dc.provenancehttps://v2.sherpa.ac.uk/id/publication/2599...Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.en_AU
dc.publisherBioMed Centralen_AU
dc.relationhttp://purl.org/au-research/grants/nhmrc/1092674en_AU
dc.relationhttp://purl.org/au-research/grants/nhmrc/1136128en_AU
dc.rights© The Author(s). 2020en_AU
dc.rights.licenseCreative Commons Attribution License (CC BY)en_AU
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_AU
dc.sourceInternational Journal for Equity in Healthen_AU
dc.source.urihttps://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01235-yen_AU
dc.subjectSocioeconomic inequalitiesen_AU
dc.subjectSocioeconomic position,en_AU
dc.subjectEducationen_AU
dc.subjectDisadvantageen_AU
dc.subjectCoronary proceduresen_AU
dc.subjectMyocardial infarctionen_AU
dc.subjectAnginaen_AU
dc.subjectAngiographyen_AU
dc.subjectRevascularisationen_AU
dc.titleEducation-related variation in coronary procedure rates and the contribution of private health care in Australia: a prospective cohort studyen_AU
dc.typeJournal articleen_AU
dcterms.accessRightsOpen Accessen_AU
local.bibliographicCitation.issue139en_AU
local.bibliographicCitation.lastpage12en_AU
local.bibliographicCitation.startpage1en_AU
local.contributor.affiliationHughes, Veronica, College of Health and Medicine, ANUen_AU
local.contributor.affiliationPaige, Ellie, College of Health and Medicine, ANUen_AU
local.contributor.affiliationWelsh, Jennifer, College of Health and Medicine, ANUen_AU
local.contributor.affiliationJoshy, Grace, College of Health and Medicine, ANUen_AU
local.contributor.affiliationBanks, Emily, College of Health and Medicine, ANUen_AU
local.contributor.affiliationKorda, Rosemary, College of Health and Medicine, ANUen_AU
local.contributor.authoremailu4966053@anu.edu.auen_AU
local.contributor.authoruidHughes, Veronica, u5801143en_AU
local.contributor.authoruidPaige, Ellie, u4966053en_AU
local.contributor.authoruidWelsh, Jennifer, u2549463en_AU
local.contributor.authoruidJoshy, Grace, u5029881en_AU
local.contributor.authoruidBanks, Emily, u4106314en_AU
local.contributor.authoruidKorda, Rosemary, u4013381en_AU
local.description.notesImported from ARIESen_AU
local.identifier.absfor111706 - Epidemiologyen_AU
local.identifier.absseo920205 - Health Education and Promotionen_AU
local.identifier.ariespublicationU1070655xPUB248en_AU
local.identifier.citationvolume19en_AU
local.identifier.doi10.1186/s12939-020-01235-yen_AU
local.identifier.uidSubmittedByU1070655en_AU
local.publisher.urlhttps://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01235-yen_AU
local.type.statusPublished Versionen_AU

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