Sex, Socioeconomic Status, Access to Cardiac Catheterization, and Outcomes for Acute Coronary Syndromes in the Context of Universal Healthcare Coverage

Abstract

Background Sex and neighborhood socioeconomic status (nSES) may independently affect the care and outcomes of acute coronary syndromes (ACS), partly through barriers in timely access to cardiac catheterization. We sought to determine whether sex modifies the association between nSES, and the receipt of cardiac catheterization and mortality following an ACS in a universal healthcare system. Methods and Results We studied 14,012 ACS patients admitted to cardiology services between April 18, 2004 and December 31, 2011 in Southern Alberta, Canada. We used multivariable logistic regression to compare the odds of cardiac catheterization within 2 and 30 days of admission and the odds of 30-day and 1-year mortality for men and women by quintile of neighborhood median household income. Significant relationships between nSES and the receipt of cardiac catheterization and mortality after ACS were detected for women but not men. When examined by nSES, each incremental decrease in neighborhood income quintile for women was associated with a 6% lower odds of receiving cardiac catheterization within 30 days (p=0.01) and a 14% higher odds of 30-day mortality (p=0.03). For men, each decrease in neighborhood income quintile was associated with a 2% lower odds of receiving catheterization within 30 days (p=0.10), and a 5% higher odds of 30-day mortality (p=0.36). Conclusions Associations between nSES and receipt of cardiac catheterization and 30-day mortality were noted for women but not men in a universal healthcare system. Care protocols designed to improve equity of access to care and outcomes are required, especially for low-income women.

Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants

“…The use of area‐level socioeconomic exposures likely represent contextual factors of the physical and social environment such as social position, physical environment, and crime associated with health as opposed to individual‐level characteristics. Reassuringly, however, many previous studies (including some in the jurisdiction that we studied) have shown the prognostic relevance of this area‐level estimation of socioeconomic status in patients presenting with myocardial infarction 3, 6, 20, 22. Consequently, our findings highlight the contextual associations of area‐level socioeconomic factors on access to cardiac catheterization and short‐term mortality in nonmetropolitan ACS patients.…”

“…Area‐level median household income was determined using postal code information linked to the 2006 Canadian census, as in previous studies 6, 20, 21, 22. Study participants were then divided evenly into area‐level median income quintiles, with the lowest income quintile coded as quintile 1 and the highest area income quintile coded as quintile 5, as in previous studies 6, 9, 14, 20.…”

“…An excess risk of death has been linked to lower neighborhood income and area median household income in the setting of acute coronary syndromes (ACS),3, 4, 5, 6 in part because of barriers to timely medical care and proven evidence‐based interventions 7, 8. Several studies have shown income‐related disparities in the use of evidence‐based therapies such as invasive cardiac procedures 3, 6, 9. These disparities may lead to worse outcomes because timely receipt of these procedures improves outcomes for appropriate patients in the setting of ACS 10, 11, 12…”

Asthma Status and Risk of Incident Myocardial Infarction: A Population-Based Case-Control Study

“…First, certain epidemiological and behavioral risk factors for MI are risk factors for asthma such as female, 40 non-Hispanic African Americans, 41, 42 low socioeconomic status, 43, 44 or smoking exposure 45 suggesting these factors as are confounders. Other factors such as physical inactivity or obesity 46, 47 as a result of active asthma might be plausible and, in turn, might increase the risk of MI.…”

Impact of Socioeconomic Status on In-Hospital Outcome of Patients with Acute Coronary Syndrome in Egypt

“…Other studies revealed that a higher risk of mortality has been associated with lower SES in the setting of ACS [33]. This is because of obstacles to in-time medical care and settled appropriate interventions [34].…”