title: Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia.
abstract: BACKGROUND
  Aboriginal people have a disproportionately higher incidence rate of ischaemic heart disease (IHD) than non-Aboriginal people. The findings on Aboriginal disparity in receiving coronary artery procedures are inconclusive. We describe the profile and transfers of IHD patients admitted to rural hospitals as emergency admissions and investigate determinants of transfers and coronary angiography.
  
  
  METHODS
  Person-linked hospital and mortality records were used to identify 28-day survivors of IHD events commencing at rural hospitals in Western Australia. Outcome measures were receipt of coronary angiography, transfer to a metropolitan hospital, and coronary angiography if transferred to a metropolitan hospital.
  
  
  RESULTS
  Compared to non-Aboriginal patients, Aboriginal patients with IHD were more likely to be younger, have more co-morbidities, reside remotely, but less likely to have private insurance. After adjusting for demographic characteristics, Aboriginal people with MI were less likely to be transferred to a metropolitan hospital, and if transferred were less likely to receive coronary angiography. These disparities were not significant after adjusting for comorbidities and private insurance. In the full multivariate model age, comorbidities and private insurance were adversely associated with transfer to a metropolitan hospital and coronary angiography.
  
  
  CONCLUSIONS
  Disparity in receiving coronary angiography following emergency admission for IHD to rural hospitals is mediated through the lower likelihood of being transferred to metropolitan hospitals where this procedure is performed. The likelihood of a transfer is increased if the patient has private insurance, however, rural Aboriginal people have a lower rate of private insurance than their non-Aboriginal counterparts. Health practitioners and policy makers can continue to claim that they treat Aboriginal and non-Aboriginal people alike based upon clinical indications, as private insurance is acting as a filter to reduce rural residents accessing interventional cardiology. If health practitioners and policy makers are truly committed to reducing health disparities, they must reflect upon the broader systems in which disparity is perpetuated and work towards a systems improvement.
authors.affiliation: Western Australian Centre for Rural Health, The University of Western Australia, Crawley, Western Australia, Australia. derrick.lopez@uwa.edu.au.
authors.forename: Derrick
authors.initials: D
authors.lastname: Lopez
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.forename: John A
authors.initials: JA
authors.lastname: Woods
authors.forename: Michael S T
authors.initials: MS
authors.lastname: Hobbs
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Knuiman
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thompson
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D017023:Coronary Angiography; D004636:Emergency Service, Hospital; D005260:Female; D006297:Health Services Accessibility; D006303:Health Services, Indigenous; D054625:Healthcare Disparities / Q000208:ethnology*; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000208:ethnology*; D016017:Odds Ratio; D010360:Patient Transfer; D011237:Predictive Value of Tests; D019035:Rural Health Services; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology