Socioeconomic inequities in invasive cardiac procedures among patients with incident angina pectoris or myocardial infarction.
OBJECTIVE
In many countries, systematic socioeconomic disparities have emerged in the use of invasive cardiac procedures among myocardial infarction patients and hospitalized coronary patients. This study prospectively examined socioeconomic differences in the use of cardiac procedures in a national cohort of incident coronary patients.


METHODS
The data were based on individual register linkages among 49,846 patients with incident angina pectoris (AP) or myocardial infarction (MI) during one-year follow-up in 1995-98 in Finland. Socioeconomic differences in invasive coronary procedures were examined using proportional hazard models.


RESULTS
The analyses showed that women, AP patients, and persons with lower socioeconomic status received fewer procedures during the one-year follow-up than men, MI patients, and those with higher socioeconomic status. Socioeconomic differences in the utilization of cardiac procedures were similar in both AP and MI groups, among both men and women, and by all socioeconomic indicators: social class, education, and income. Disparities were already emerging after the 28-day follow-up among men and women in both patient groups, and they persisted throughout the study period. Controlling for disease severity, comorbidity, and hospital district did not modify the results.


CONCLUSIONS
Socioeconomic disparities in receiving invasive coronary procedures among AP patients without MI were similar to those in MI patients.
Hetemaa
Tiina
T
National Research and Development Centre for Welfare and Health (STAKES), Outcomes and Equity Research, Helsinki, Finland. tiina.hetemaa@stakes.fi
Manderbacka
Kristiina
K
Reunanen
Antti
A
Koskinen
Seppo
S
Keskimäki
Ilmo
I
D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D012959:Socioeconomic Factors