title: Different needs or treated differently? Understanding ethnic inequalities in coronary revascularisation rates.
abstract: BACKGROUND
  Several studies have reported major ethnic inequalities in cardiac revascularisation. This paper attempts to explain why in New Zealand, Māori and Pacific patients may be less likely to receive cardiac revascularisation interventions than Europeans.
  
  
  METHODS
  Angiograms of 55 Māori, 45 Pacific and 100 age-sex matched European patients with ST elevation myocardial infarction were reviewed by two cardiologists blinded to the patients' ethnicity to determine ethnic differences in actual and recommended revascularisation likelihood.
  
  
  RESULTS
  Māori and Pacific patients were 18% (95% C.I. 6%-29%) less likely to receive cardiac revascularisation procedures compared to European patients. If intervention had been based on the recommendation from blinded angiogram review they would have been 14% (2%-24%) less likely to receive revascularisation. Māori and Pacific were significantly more likely to be recommended for CABG (RR=2.9; C.I. 1.4-5.8) and less likely for PCI (RR=0.60; 0.48-0.75). Māori and Pacific were at significantly higher risk of under-treatment overall (RR=5.0; 1.1-22.8) and for CABG (RR=8.0; 1.0-64.0), but not for PCI (RR=2.0; 0.2-22.1). However these relative risks became non-significant when cases not eligible for surgery due to comorbidities were excluded.
  
  
  CONCLUSIONS
  Māori and especially Pacific STEMI patients present with a pattern of ischaemic heart disease that is less amenable to PCI, even after allowing for differences in the number of diseased vessels and diabetes prevalence. The lower likelihood of Māori and Pacific patients receiving recommended CABG is largely explained by higher comorbidity prevalence.
authors.affiliation: Planning Funding and Outcomes Department, Waitemata District Health Board, Auckland, NZ. Electronic address: peter.sandiford@waitematadhb.govt.nz.
authors.forename: Peter
authors.initials: P
authors.lastname: Sandiford
authors.affiliation: Cardiology Department, Waitemata District Health Board, Auckland, NZ.
authors.forename: Seifeddin S
authors.initials: SS
authors.lastname: El-Jack
authors.affiliation: Cardiology Department, Waitemata District Health Board, Auckland, NZ.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Scott
authors.affiliation: Planning Funding and Outcomes Department, Waitemata District Health Board, Auckland, NZ.
authors.forename: Sue M
authors.initials: SM
authors.lastname: Crengle
authors.affiliation: Chief Executive, Waitemata District Health Board, Auckland, NZ.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Bramley
mesh_terms: D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000601:surgery*; D009520:New Zealand / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016037:Single-Blind Method; D044465:White People / Q000706:statistics & numerical data*
keywords: Coronary Artery Bypass Grafting; Ethnic groups; Inequalities; Māori; Pacific; Percutaneous Coronary Intervention