Immigrant status and disparities in health care delivery in patients with myocardial infarction.
BACKGROUND
We investigated the differences in socioeconomic status and quality health care between Singapore-born citizens and immigrants presenting with ST-segment elevation myocardial infarction (STEMI).


METHODS
In a prospective study, patients admitted with STEMI were recruited for a questionnaire survey. The recruited patients were categorized based on their immigration status into Singapore-born citizens (SBC), foreign-born citizens (FBC), permanent residents (PR) and non-residents (NR).


RESULTS
Among the 374 recruited patients, 286 (76.5%) patients were categorized as SBC, and the remaining 88 (23.5%) as immigrants. Further breakdown of the immigrants revealed that 33 were FBC (median duration of living in Singapore, 53 years), 22 were PR (18 years), and 33 were NR (11 years). Significant differences in socioeconomic status among SBC, FBC, PR and NR were detected. NR were in the lowest, while PR in the highest, socioeconomic class based on occupation (p=0.003), education level (p<0.001), and average monthly household income (p=0.020). There were no disparities in the proportion of patients treated with primary PCI (SBC 88%, FBC 82%, PR 91%, NR 79%, p=0.555). Median door-to-balloon times were similar among the four groups (56, 52, 60, 56min, p=0.614). Compared with SBC, PR was associated with longer symptom-to-balloon times (median difference 54.1 min; 95% CI 9.0 to 99.2).


CONCLUSIONS
There were major differences in the socioeconomic status among SBC, FBC, PR and NR who presented with STEMI. Although there were no major disparities in access to high quality health care to these patients with different immigration status, symptom-to-balloon time differed substantially among the different migrant classes.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. mdclchr@nus.edu.sg
Chi-Hang
CH
Lee
Hyekyung
H
Choo
Bee-Choo
BC
Tai
Mark Y
MY
Chan
Qian-Hui
QH
Phua
Ting-Ting
TT
Low
A Mark
AM
Richards
Huay-Cheem
HC
Tan
Rosaleen
R
Ow
Tiong-Cheng
TC
Yeo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000191:economics / Q000208:ethnology*; D054242:Emigrants and Immigrants; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000208:ethnology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome