title: Persistent socio-economic differences in revascularization after acute myocardial infarction despite a universal health care system-a Danish study.
abstract: BACKGROUND
  Use of invasive revascularization [percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)] after acute myocardial infarction (AMI) in Denmark increased between 1996 and 2004. We investigated how this affected socioeconomic differences in their use.
  
  
  METHODS
  All patients aged 30-74 years in hospital for a first AMI in Denmark between 1996 and 2004 were included. Cox proportional hazard models were used to estimate the association between individual income (tertiles) and education (>12, 10-12 and <10 years) and time to revascularization within 6 months. Revascularization was stratified into CABG, acute PCI (within 2 days of admission) and non-acute PCI (after the third day).
  
  
  RESULTS
  A total of 38,803 patients were included. In 1996-1998, 6.8% received CABG, 9.3% non-acute PCI and 2.4% acute PCI; in 2002-2004, these numbers were 11.8, 36.1 and 29.1%. CABG was more likely to be performed for patients with a high income [hazard ratio (HR), 1.18; 95% confidence interval (CI), 1.08-1.28] or a medium income (HR, 1.16; 95% CI, 1.07-1.25) than for those with a low income throughout the period. A similar income gradient was seen for non-acute PCI, but not for acute PCI, for which no gradient was seen. No educational gradient was found for CABG, and that for non-acute and acute PCI decreased during the period; by the end of the period, more patients with low than high education received acute PCI.
  
  
  CONCLUSIONS
  In the universal health care system of Denmark, income differences in CABG and non-acute PCI persisted, whereas no such differences were seen for acute PCI.
authors.affiliation: National Institute of Public Health, Øster Farimagsgade 5A, 1399, Copenhagen K, Denmark. jeppenr@dadlnet.dk
authors.forename: Jeppe N
authors.initials: JN
authors.lastname: Rasmussen
authors.forename: Søren
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
authors.forename: Steen Z
authors.initials: SZ
authors.lastname: Abildstrom
authors.forename: Tina K
authors.initials: TK
authors.lastname: Schramm
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Finn
authors.initials: F
authors.lastname: Diderichsen
authors.forename: Merete
authors.initials: M
authors.lastname: Osler
authors.forename: Mette
authors.initials: M
authors.lastname: Madsen
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012959:Socioeconomic Factors