Inequality in treatment use among elderly patients with acute myocardial infarction: USA, Belgium and Quebec.
BACKGROUND
Previous research has provided evidence that socioeconomic status has an impact on invasive treatments use after acute myocardial infarction. In this paper, we compare the socioeconomic inequality in the use of high-technology diagnosis and treatment after acute myocardial infarction between the US, Quebec and Belgium paying special attention to financial incentives and regulations as explanatory factors.


METHODS
We examined hospital-discharge abstracts for all patients older than 65 who were admitted to hospitals during the 1993-1998 period in the US, Quebec and Belgium with a primary diagnosis of acute myocardial infarction. Patients' income data were imputed from the median incomes of their residential area. For each country, we compared the risk-adjusted probability of undergoing each procedure between socioeconomic categories measured by the patient's area median income.


RESULTS
Our findings indicate that income-related inequality exists in the use of high-technology treatment and diagnosis techniques that is not justified by differences in patients' health characteristics. Those inequalities are largely explained, in the US and Quebec, by inequalities in distances to hospitals with on-site cardiac facilities. However, in both Belgium and the US, inequalities persist among patients admitted to hospitals with on-site cardiac facilities, rejecting the hospital location effect as the single explanation for inequalities. Meanwhile, inequality levels diverge across countries (higher in the US and in Belgium, extremely low in Quebec).


CONCLUSIONS
The findings support the hypothesis that income-related inequality in treatment for AMI exists and is likely to be affected by a country's system of health care.
Perelman
Julian
J
Escola Nacional de Saúde Pública, Universidade Nova de Lisboa and CIESP, Universidade Nova de Lisboa, 1600-560 Lisbon, Portugal. jperelman@ensp.unl.pt
Shmueli
Amir
A
McDonald
Kathryn M
KM
Pilote
Louise
L
Saynina
Olga
O
Closon
Marie-Christine
MC
D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D019992:Databases as Topic; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery / Q000628:therapy*; D011792:Quebec; D012923:Social Class; D014481:United States