title: Specialized cardiological care may be overutilized in urban areas of Quebec.
abstract: BACKGROUND
  Urban/rural differences in secondary cardiovascular disease (CVD) events have previously been observed for Québec. These differences could be attributable to differential utilization of specialized cardiological care, such as revascularization procedures and visits to cardiologists; if this were the case, policies to increase utilization in rural areas would be indicated.
  
  
  METHODS
  This is a population-based cohort study.
  
  
  METHODS
  We analysed mortality and hospital re-admission in Québec within 1 year after an initial cardiovascular event in relation to urban/rural location and specialized care utilization, controlling for demography, comorbidities, and cumulative hospitalization.
  
  
  RESULTS
  Analysis showed higher hospital re-admissions and slightly lower CVD mortality in rural areas, as well as less use of specialized care in rural areas. However, urban/rural differentials were not attributable to differences in utilization of care. Paradoxically, comorbidities were lower among patients who saw specialists.
  
  
  CONCLUSIONS
  Ultimately, urban/rural differences in secondary CVD outcomes were not attributable to differences in care utilization or our measures of underlying health status, and were likely due to cultural or lifestyle factors that are both hard to model and hard to change through policy. There appears to be overutilization of specialized care in urban areas, an issue which requires further study. Our results suggest that substantial caution is required when interpreting health service usage data and that critical factors in the relationship between specialized cardiological care and outcomes are still poorly understood at a population level.
authors.affiliation: University of Sherbrooke, Sherbrooke, QC, Canada. alan.cohen@usherbrooke.ca
authors.forename: Alan A
authors.initials: AA
authors.lastname: Cohen
authors.forename: Alain
authors.initials: A
authors.lastname: Vanasse
authors.forename: Josiane
authors.initials: J
authors.lastname: Courteau
mesh_terms: D000368:Aged; D002309:Cardiology / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009819:Office Visits / Q000706:statistics & numerical data; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013997:Time Factors; D019037:Urban Health Services / Q000706:statistics & numerical data*