Does access to invasive examination and treatment influence socioeconomic differences in case fatality for patients admitted for the first time with non-ST-elevation myocardial infarction or unstable angina?
OBJECTIVE
Our aim was to investigate whether there is social inequality in access to invasive examination and treatment, and whether access explains social inequality in case fatality in a nationwide sample of patients admitted for the first time with unstable angina or non-ST-elevation myocardial infarction (NSTEMI) in Denmark.


RESULTS
All patients admitted for the first time with NSTEMI (n=16,625) or unstable angina (n=8,800) from 2001 to 2009 in Denmark were included. We measured time from admission to coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The outcomes were 30-day and one-year case fatality. We found social inequality in access to CAG and one-year case fatality for both NSTEMI and unstable angina patients, but the time waited for CAG did not explain the social inequality in case fatality.


CONCLUSIONS
Despite nominal equal access to health care, social inequality in case fatality after NSTEMI and unstable angina exists in Denmark. The patients with the shortest education waited longer for angio-graphy; however, this did not seem to explain inequality in case fatality. This register-based study was approved by the Danish Data Protection Agency (Approval number 2010-41-5263). Register-based studies do not need approval by a medical ethics committee in Denmark.
Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark.
Solvej
S
Mårtensson
Dorte
D
Gyrd-Hansen
Eva
E
Prescott
Per Kragh
PK
Andersen
Gunnar
G
Gislason
Rikke Kart
RK
Jacobsen
Merete
M
Osler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000628:therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000191:economics / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome