title: [Equity of access to percutaneous transluminal coronary angioplasty (PTCA) among patients with acute myocardial infarction in Tuscany Region (Central Italy), 2001-2008].
abstract: OBJECTIVE
  assessing the equity in the access to the percutaneous transluminal coronary angioplasty (PTCA) and in its time trend among patients with ST-elevation acute myocardial infarction.
  
  
  METHODS
  observational study based on regional administrative data: Hospital Discharge Registry, Health Registry, and 2001 Census data. Two indexes were used as deprivation measure: deprivation status at small area level (as proxy of the individual deprivation) and deprivation status at Local Health Agency level. The residence in a mountain municipality was used as extra measure of contextual deprivation.
  
  
  METHODS
  patients with first emergency hospital admission for acute myocardial infarction (AMI) with ST-elevation, resident in Tuscany Region (Central Italy) and hospitalized during the period 2001-2008.
  
  
  METHODS
  relative risk (RR) of the PTCA utilization.
  
  
  RESULTS
  multivariate analysis by multilevel multiple logistic regression showed a significant lower PTCA utilization in females (RR: 0.91, p <0.0001), in patients with high deprivation status at Local Health Agency level (RR: 0.71, p <0.0001), in residents in a mountain municipality (RR: 0.90, p <0.0001), and in patients with comorbidity (RR: 0.98, p =0.006; RR: 0.87, p <0.0001; RR: 0.69, p <0.0001 for Charlson comorbidity index equal to 1, 2, ≥3, respectively). The PTCA utilization over time has grown significantly (p <0.0001), from 26.6% in 2001 to 57.4% in 2008. This increase was more pronounced in patients with high deprivation status at Local Health Agency level (RR: 4.01, p <0.0001 for year 2008 vs. 2001), with consequent reduction of the initial differential with respect to patients with low deprivation status at Local Health Agency level (RR: 0.40, p <0.0001 in 2001 and RR: 0.93, p =0.114 in 2008). However, the differential associated with gender and residence in a mountain municipality persisted over time.
  
  
  CONCLUSIONS
  In Tuscany during the period 2001-2008 a significant reduction of the differential in the PTCA utilization associated with the deprivation status at Local Health Agency level was observed. This finding could be explained by the diffusion and organization of suitable invasive cardiology units in the region, the organizational models of care, the different propensity to the PTCA utilization by the referral hospitals.
authors.forename: Manuele
authors.initials: M
authors.lastname: Falcone
authors.forename: Simone
authors.initials: S
authors.lastname: Del Santo
authors.forename: Silvia
authors.initials: S
authors.lastname: Forni
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pepe
authors.forename: Marco
authors.initials: M
authors.lastname: Marchi
authors.affiliation: Unità di epidemiologia e biostatistica, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche e Fondazione toscana G. Monasterio, Pisa-Massa. giuseppe.rossi@ifc.cnr.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D055815:Young Adult
vernacular_title: Equità nell'accesso all'angioplastica coronarica transluminale percutanea (ACTP) nei pazienti con infarto miocardico acuto in Toscana, 2001-2008.