Socioeconomic differences in the use and outcomes of hospital treatment for ischaemic heart diseases
Year: 2014
Type: article
Study design: Observational Study
Abstract: The importance of CHD to public health is due not only to the high prevalence of, and mortality due to, the disease, but also to the result of costly invasive treatments such as coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI). Although CHD mortality has markedly declined in Finland over the past few decades, it is still the main cause of death. The general aims of this study were to evaluate and describe socioeconomic differences in the use of coronary procedures and the outcomes of CHD patients and to elucidate the factors that have an effect on differences, such as the change in supply for invasive treatments of CHD, the duration of follow-up, co-morbidity, disease severity and regional variations in procedure rates. The study also examines whether similar socioeconomic disparities in invasive treatments and outcomes of CHD exist in patients with chronic angina pectoris (AP), and with potentially more effective access to secondary prevention, such as in patients with acute myocardial infarction (MI) as the first sign of CHD. Data from 1988 to 1998 was gathered from administrative registers of the Social Insurance Institution, Statistics Finland, and STAKES. For each original study the necessary register linkages were performed in Statistics Finland and personal identification numbers were encrypted before the data was transferred to the researchers. The study protocols of the original studies were approved by the Finnish Data Protection Ombudsman and the Ethics Research Committee of STAKES. Age-adjusted rates were calculated for coronary operations, hospitalisations due to CHD, CHD and all cause mortality, and incidences of MI and its case fatality, for men and women separately by social category, as measured by education, occupational driven socioeconomic status, and income. The results of this study indicate that similar patterns emerged in the use of cardiac procedures according to all socioeconomic indicators: patients with higher socioeconomic status underwent more procedures than patients from lower groups. This applied to both patient groups, AP and MI patients, and both genders. Those of higher socioeconomic status also benefitted first from cardiac procedures. More attention should therefore be paid to the equitable distribution of scarce health care resources. Socioeconomic differences in CHD outcomes also exist among angina patients. These results suggest that targeted measures of secondary prevention are needed among CHD patients with lower socioeconomic status to reduce socioeconomic disparities in fatal and non-fatal coronary events. To improve equity, it is vital that all patients should have access to health care and receive treatments according to their need, not according to the social category to which they belong to or to their gender.
Author: Tiina Hetemaa
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2159539397