title: Disparities in health care delivery and hospital outcomes between non-Saudis and Saudi nationals presenting with acute coronary syndromes in Saudi Arabia.
abstract: BACKGROUND
  Saudi Arabia has a non-Saudi workers population. We investigated the differences and similarities of expatriate non-Saudi patients (NS) and Saudi nationals (SN) presenting with acute coronary syndromes (ACS) with respect to therapies and clinical outcomes.
  
  
  METHODS
  The study evaluated 2031 of the 5055 ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) from 2005 to 2007. Propensity score matching and logistic regression analysis were performed to account for major imbalances in age and sex in the two groups.
  
  
  RESULTS
  The mean patient age was 56.2±9.8, and 83.5% of the study cohort were male. SN were more likely to have risk factors of atherosclerosis. ST-elevation MI (STEMI) was the most common ACS presentation in NS, while non-ST ACS was more common in SN. The median symptom-to-door time was significantly greater in NS patients (Median 175 min (197) vs. 130 min (167), p=0.027). The only difference in pharmacological therapies between the two groups was that NS were more likely to receive fibrinolytic therapy. NS were less likely than SN to undergo percutaneous coronary interventions (PCI; 32.6% vs. 42.8%, p=0.0001) or primary PCI (7.8% vs. 22.8%, p<0.001). Hospital mortality, cardiogenic shock, and heart failure were significantly higher in NS compared to SN. After adjusting for baseline variables and therapies, the odds ratios for hospital mortality and cardiogenic shock in NS were 2.9 (95% CI 1.5-6.2, p=0.004) and 2.8 (95% CI 1.5-4.9, p<0.001), respectively.
  
  
  CONCLUSIONS
  Our findings indicate disparities in hospital care between NS and SN ACS patients. NS patients had worse hospital outcomes, which may reflect unequal health coverage and access-to-care issues.
authors.affiliation: Cardiac Sciences department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Hussam F
authors.initials: HF
authors.lastname: AlFaleh
authors.affiliation: Cardiac Sciences department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Mostafa Q
authors.initials: MQ
authors.lastname: Al Shamiri
authors.affiliation: Cardiac Sciences department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Anhar
authors.initials: A
authors.lastname: Ullah
authors.affiliation: Cardiac Sciences department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.affiliation: Cardiac Sciences department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Ahmad Salah
authors.initials: AS
authors.lastname: Hersi
authors.affiliation: Saud AlBabtain Cardiac Center, Dammam, Saudi Arabia.
authors.forename: Shukri
authors.initials: S
authors.lastname: AlSaif
authors.affiliation: Medicine Department, Security forces Hospital, Riyadh, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: AlNemer
authors.affiliation: King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
authors.forename: Amir
authors.initials: A
authors.lastname: Taraben
authors.affiliation: King Fahad General Hospital, Jeddah, Saudi Arabia.
authors.forename: Asif
authors.initials: A
authors.lastname: Malik
authors.affiliation: King Khalid National Guard Hospital, Jeddah, Saudi Arabia.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abuosa
authors.affiliation: King Abdul Aziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Mimish
authors.initials: M
authors.lastname: LA
authors.affiliation: Cardiac Sciences department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Tarek
authors.initials: T
authors.lastname: Kashour
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003695:Delivery of Health Care; D005260:Female; D054625:Healthcare Disparities; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012529:Saudi Arabia