title: Geographic and socioeconomic differences in access to revascularization following acute myocardial infarction.
abstract: Geographic and socioeconomic barriers may hinder fair access to healthcare. This study assesses geographic and socioeconomic disparities in access to reperfusion procedures in acute myocardial infarction (AMI) patients residing in Piedmont (Italy).
  
  
  
  Coronary Care Units (CCUs) were geocoded with a geographic information system (GIS) and the shortest drive time from CCUs to patients' residence was computed and categorized as 0 to <20, 20 to <40 and ≥40 min. Using data on AMI emergency hospitalizations in 2004-2012, we employed a log-binomial regression model to evaluate the relation between drive time and use of Percutaneous Transluminal Coronary Angioplasty (PTCA) occurring within 2 days after a hospitalization for an episode of AMI, and whether this relation varied depending on the period of hospitalization.
  
  
  
  A total of 29% of all cases with a diagnosis of AMI (n = 66 097), were revascularized within 2 days from the index admission. The further AMI patients lived from CCUs, the less likely they were to receive revascularization: compared with distance <20 min, RRs were respectively 0.84 [95% CI 0.80-0.88] and 0.78 [95% CI 0.71-0.86]. Findings also showed that less educated people had a lower relative risk of being revascularized compared to more educated people (RR = 0.78; 95% CI = 0.74-0.82). Both inequalities have reduced in recent years.
  
  
  
  This study provides evidence of reduced geographical and socioeconomic differences in revascularization use over time. Geography and socioeconomic status should not determine the type of treatment received for life-threatening conditions such as AMI.
authors.affiliation: Department of Economics, Statistics and Finance, University of Calabria, Rende (CS), Italy giuliana.deluca@unical.it.
authors.forename: Giuliana
authors.initials: G
authors.lastname: De Luca
authors.affiliation: Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy.|National Institute for Health, Migration and Poverty (INMP), Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Petrelli
authors.affiliation: Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Landriscina
authors.affiliation: Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gnavi
authors.affiliation: Cardiology Department, Maria Vittoria Hospital, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Giammaria
authors.affiliation: Epidemiology Unit, ASL TO3, Piedmont Region, Grugliasco, Italy.|Department of Clinical and Biological Science, University of Turin, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D012923:Social Class; D055815:Young Adult