Is There Inequity in Hospital Care Among Patients With Acute Coronary Syndrome Who Are Proficient and Not Proficient in English Language?: Analysis of the SNAPSHOT ACS Study.
BACKGROUND
The provision of equitable acute coronary syndrome (ACS) care in Australia and New Zealand requires an understanding of the sources of variation in the provision of this care.


OBJECTIVE
The aim of this study was to compare the variation in care and outcomes between ACS patients with limited English proficiency (LEP) and English proficiency (EP) admitted to Australian and NZ hospitals.


METHODS
Data were collected from 4387 suspected/confirmed ACS patients from 286 hospitals between May 14 and 27, 2012, who were followed for 18 months. We compared hospital care and outcomes according to the proficiency of English using logistic regressions.


RESULTS
The 294 LEP patients were older (70.9 vs 66.3 years; P < .001) and had higher prevalence of hypertension (71.1% vs 62.8%; P = .004), diabetes (40.5% vs 24.3%; P < .001), and renal impairment (16.3% vs 11.1%; P = .007) compared with the 4093 EP patients. Once in hospital, there was no difference in receipt of percutaneous coronary intervention (57.0% vs 55.4%; P = .78) or coronary artery bypass graft surgery (10.5% vs 11.5%; P = .98). After adjustment for medical history, there were no significant differences (P > .05) between the 2 groups in the risk of major adverse cardiovascular events and/or all-cause death during the index admission and from index admission to 18 months.


CONCLUSIONS
These results suggest that LEP patients admitted to Australian or New Zealand hospitals with suspected ACS may not experience inequity in hospital care and outcomes.
Karice K. Hyun, MAppStats PhD candidate, The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia. Julie Redfern, PhD Deputy Director, Cardiovascular Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia. Mark Woodward, PhD Professor of Statistics and Epidemiology, The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia, and The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, UK. Tom Briffa, PhD Associate Professor, School of Population Health, University of Western Australia, Perth, Australia. Derek P. Chew, MPH Cardiologist, Department of Cardiology, Flinders University, Adelaide, Australia. Chris Ellis, BM Cardiologist, Department of Cardiology, Auckland City Hospital, Auckland, New Zealand. John French, MBBS Cardiologist, Department of Cardiology, University of NSW, Liverpool Hospital, Sydney, Australia. Carolyn Astley, PhD Research Lead, The Heart Foundation, South Australia Division, Adelaide, Australia. Greg Gamble, MSc Biostatistician, Department of Medicine, University of Auckland, Auckland, New Zealand. Kellie Nallaiah, MPH Project Manager, The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia. Tegwen Howell, MEcSt Manager, Research Support Network, Queensland Emergency Medicine Research Foundation, Brisbane, Australia. Karen Lintern, BHlth Cardiac Project Officer, Agency for Clinical Innovation, Sydney, Australia. Robyn Clark, PhD Professor of Nursing, Flinders University, Adelaide, Australia. Kannikar Wechkunanukul, MPharm PhD Candidate, School of Nursing and Midwifery, Flinders University, Adelaide, Australia. David Brieger, PhD Cardiologist, Department of Cardiology, Concord Hospital, University of Sydney, Australia.
Karice K
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Hyun
Julie
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Redfern
Mark
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Derek P
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Chew
Chris
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French
Carolyn
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Astley
Greg
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Kellie
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Nallaiah
Tegwen
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Karen
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Wechkunanukul
David
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Brieger
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D007802:Language; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic