Increasing resources effected equity in access to revascularizations for patients with diabetes.
OBJECTIVE
To examine differences in access to coronary revascularization among a cohort of coronary patients with and without diabetes in 1995-2002 in Finland and to examine how rapidly increasing resources effected socioeconomic equity in access to these operations.


METHODS
An individual level nationwide register-based study of newly diagnosed CHD (coronary heart disease) patients (aged 40-79) in Finland. Rates for revascularizations were calculated per 1 000 person years. Socioeconomic differences were examined using Cox regression.


RESULTS
Revascularization rates increased from 354 to 443 per 1 000 person years among men with CHD and from 301 to 366 among patients with diabetes. Among women with CHD the numbers were 224 and 249 and among patients with diabetes 208 and 325. Comparing trends for first revascularization between patient groups with and without diabetes differences increased somewhat among men. Among women, revascularization rates increased more among diabetic patients. Lower revascularization rates among lower socioeconomic groups were found throughout the study period in both patient groups.


CONCLUSIONS
Simultaneously with large increase in cardiac operation rates, revascularization observed more common among women with diabetes compared to those without. However socioeconomic inequity in access to revascularizations among both genders remained even after increase in resources.
Vehko
Tuulikki
T
National Institute for Health and Welfare (THL), Helsinki, Finland. tuulikki.vehko@thl.fi
Manderbacka
Kristiina
K
Arffman
Martti
M
Reunanen
Antti
A
Keskimäki
Ilmo
I
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000191:economics / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D019983:Guideline Adherence; D017048:Health Care Costs; D015276:Health Care Rationing / Q000191:economics; D006292:Health Priorities / Q000191:economics; D006295:Health Resources / Q000191:economics / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome