Ethnic Differences in Coronary Revascularisation following an Acute Coronary Syndrome in New Zealand: A National Data-linkage Study (ANZACS-QI 12).
BACKGROUND
The aim of this study was to describe ethnic differences in angiography and revascularisation rates following an acute coronary syndrome (ACS) in New Zealand.


METHODS
National hospitalisation and mortality data were anonymously linked to determine receipt of angiography and revascularisation for 30-84 year-olds hospitalised with ACS between 2007 and 2012. Multilevel Cox regression, accounting for individual factors and admitting hospital, was used to estimate adjusted procedural rates within 30 days of admission.


RESULTS
Of the 50,324 ACS patients included, 10% were Māori, 4% Pacific, 3% Indian and 83% New Zealand European or Other ethnicities (NZEO). A larger proportion of Māori (48%) than NZEO (36%), Pacific (19%) and Indian (14%) patients were admitted to hospitals without catheterisation facilities. More Māori and Pacific (22-24%) than NZEO and Indian patients (12-13%) had severe comorbidities. Māori and Pacific were less likely than NZEO patients to receive angiography (adjusted HRs 0.94 [0.91-0.98] and 0.93 [0.87-0.98] respectively) and revascularisation (adjusted HRs 0.79 [0.75-0.83] and 0.77 [0.71-0.83]), even after adjusting for important demographic and clinical factors.


CONCLUSIONS
A higher comorbidity burden in Māori and Pacific patients and reduced access to catheterisation facilities for non-urban Māori contributed to lower procedure rates after ACS admission. Ethnic differences remained after adjustment for these factors and require further investigation.
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand. Electronic address: c.grey@auckland.ac.nz.
Corina
C
Grey
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Rod
R
Jackson
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Susan
S
Wells
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
Deborah
D
Randall
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Matire
M
Harwood
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Suneela
S
Mehta
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Daniel J
DJ
Exeter
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand; Middlemore Hospital, Auckland, New Zealand.
Andrew J
AJ
Kerr
D054058:Acute Coronary Syndrome / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality / Q000601:surgery; D009520:New Zealand / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention
Acute coronary syndromes; Coronary revascularisation; Myocardial infarction