Likelihood of Treatment in a Coronary Care Unit for a First-Time Myocardial Infarction in Relation to Sex, Country of Birth and Socioeconomic Position in Sweden

Abstract

ObjectiveTo examine the relationship between sex, country of birth, level of education as an indicator of socioeconomic position, and the likelihood of treatment in a coronary care unit (CCU) for a first-time myocardial infarction.DesignNationwide register based study.SettingSweden.Patients199 906 patients (114 387 men and 85,519 women) of all ages who were admitted to hospital for first-time myocardial infarction between 2001 and 2009.Main outcome measuresAdmission to a coronary care unit due to myocardial infarction.ResultsDespite the observed increasing access to coronary care units over time, the proportion of women treated in a coronary care unit was 13% less than for men. As compared with men, the multivariable adjusted odds ratio among women was 0.80 (95% confidence interval 0.77 to 0.82). This lower proportion of women treated in a CCU varied by age and year of diagnosis and country of birth. Overall, there was no evidence of a difference in likelihood of treatment in a coronary care unit between Sweden-born and foreign-born patients. As compared with patients with high education, the adjusted odds ratio among patients with a low level of education was 0.93 (95% confidence interval 0.89 to 0.96).ConclusionsForeign-born and Sweden-born first-time myocardial infarction patients had equal opportunity of being treated in a coronary care unit in Sweden; this is in contrast to the situation in many other countries with large immigrant populations. However, the apparent lower rate of coronary care unit admission after first-time myocardial infarction among women and patients with low socioeconomic position warrants further investigation.

Educational class inequalities in the incidence of coronary heart disease in Europe

“…Conversely, in populations from the Nordic countries, Scotland and Lithuania more than 80% of inequalities in mortality were due to differential incidence. In northern Sweden, the proportion attributable to case-fatality was much higher for women than for men, possibly reflecting gender differences in the rate of admission to acute coronary care units 20. Inequalities in case-fatality have been mainly attributed to prehospital deaths,21–23 which reflect both events’ severity and delay in hospital presentation among less educated people 24.…”

Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990–1994 and 2005–2009

“…A recent study presenting inequalities in secondary prevention after CVD in 21 countries reported Sweden as one of the countries providing most equitable access to the relevant drugs (antiplatelet, cholesterol and blood-pressure-lowering) 39. It has, however, been indicated that treatment intensity at coronary care units after first MI is lower for men with low compared with high educational level 40. Other studies have also found evidence that statin medication is given preferentially to patients with a higher SEP after stroke41 or MI 42.…”