Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

Abstract

BackgroundUniversal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan's health-care system, which is mainly publicly funded.MethodsWe chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients' clinical status.ResultsWe found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69–1.03) or in-hospital mortality (1.00; 0.68–1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34–0.71).ConclusionsUnder Japan's current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care.

Temporal trends and socioeconomic differences in treatment and mortality following a diagnosis of aortic stenosis

“…Our study finds that a higher mortality following AVR is related to a lower level of education, primarily within the first year after the procedure. In line with our results, other studies have found minor social disparities in mortality after AVR [2,37,38,47]; however, other studies have found no differences in mortality [33,34]. Common for all the studies are the lack of individual-level information on SES.…”

“…There were no differences in comorbidity level for those receiving TAVR versus those treated conservatively. However, in Japan, a country with universal health care coverage, there was no area-based social disparity in the treatment rate of aortic stenosis [33].…”

“…Since aortic stenosis shares risk factors with those of other noncommunicable diseases such as atherosclerosis, one could assume that the association is also present in the treatment and mortality of aortic stenosis. The results are conflicting, with several studies finding no SES differences in treatment or mortality rates [33][34][35], while other studies have found a small negative effect of low SES on risk of treatment [36] and long-term survival [37,38]. Common for all the mentioned studies is the lack of data on individual SES, since all information on SES is area-based.…”

Labor factor barriers to seeking medical services among metropolitan workers: a cross-sectional analysis by sex using the J-SHINE study

“…In most countries, equal access to medical services is a major policy concern for achieving health equity 1 , 2) . However, access to healthcare services is affected by coverage 3) and other factors including socioeconomic circumstances 1 , 4) , care-seeking behaviors 5) , and the behavior of healthcare providers 6) .…”

“…In most countries, equal access to medical services is a major policy concern for achieving health equity 1,2) . However, access to healthcare services is affected by coverage 3) and other factors including socioeconomic circumstances 1,4) , care-seeking behaviors 5) , and the behavior of healthcare providers 6) . There is abundant evidence that age, sex 7) , income 8,9) , cohabitation status 10) , ethnicity 11) ,and employment status 12) may affect accessibility of health care.…”