title: Are There Ethnic Inequalities in Revascularisation Procedure Rate after an ST-Elevation Myocardial Infarction?
abstract: BACKGROUND
  Previously, ethnic inequalities in prognosis after a first acute myocardial infarction were observed in the Netherlands. This might be due to differences in revascularisation rate between ethnic minority groups and ethnic Dutch. Therefore, we investigated inequalities in revascularisation rate after occurrence of an ST-elevation myocardial infarction (STEMI) between first generation ethnic minority groups (henceforth, migrants) and ethnic Dutch.
  
  
  METHODS
  All STEMI events between 2006 and 2011 were identified in a subset of the Achmea Health Database, which records medical care to persons insured at the Achmea health insurance company, a major health insurance company in the central part of the Netherlands. Ethnic Dutch and migrants from Suriname (Hindustani Surinamese and non-Hindustani Surinamese), Morocco, and Turkey were included (n = 1,765). Multivariable Cox proportional hazards regression analyses were used to identify ethnic inequalities in revascularisation rate (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)) after a STEMI event.
  
  
  RESULTS
  On average, 73.2% of STEMI events were followed by a revascularisation procedure. After adjustment for confounders (age, sex, degree of urbanization) no significant differences in revascularisation rate were found between the ethnic Dutch population and Hindustani Surinamese (HR: 1.04; 0.85-1.27), non-Hindustani Surinamese (HR: 0.98; 0.63-1.51), Moroccan (HR: 0.94; 0.77-1.14), and Turkish migrants (HR: 1.04; 0.88-1.24). Additional adjustment for comorbidity and neighborhood income did not change our findings.
  
  
  CONCLUSIONS
  Our study suggests no ethnic inequalities in revascularisation rate after a STEMI event. This finding is in agreement with the universally accessible health care system in the Netherlands.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA, Utrecht, the Netherlands.
authors.forename: Aloysia A M
authors.initials: AA
authors.lastname: van Oeffelen
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Rittersma
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA, Utrecht, the Netherlands.
authors.forename: Ilonca
authors.initials: I
authors.lastname: Vaartjes
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA, Utrecht, the Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
mesh_terms: D000368:Aged; D044466:Asian People; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D009426:Netherlands