Socio‐economic Inequality in the Use of Procedures and Mortality Among AMI Patients: Quantifying the Effects Along Different Paths

Abstract

It is not known whether inequality in access to cardiac procedures translates into inequality in mortality. In this paper, we use a path analysis model to quantify both the direct effect of socio-economic status on mortality and the indirect effect of socio-economic status on mortality as mediated by the provision of cardiac procedures. The study links microdata from the Finnish and Norwegian national patient registers describing treatment episodes with data from prescription registers, causes-of-death registers and registers covering education and income. We show that socio-economic variables affect access to percutaneous coronary intervention in both countries, but that these effects are only moderate and that the indirect effects of the socio-economic factors on mortality through access to percutaneous coronary intervention are minor. The direct effects of income and education on mortality are significantly larger. We conclude that the socio-economic gradient in the use of percutaneous coronary intervention adds to socio-economic differences in mortality to little or no extent.

A EuroHOPE kutatási program módszertana

“…Azokat a módszertani kérdéseket emeltük ki, amelyek a jelen lapszámban megjelenő AMI, STR, HIP és VLBW diagnóziscsoportokkal kapcsolatos közle ményeink értelmezéséhez szükségesek. A EuroHOPE kutatás egyéb területeit a nemzetközi publikációkból [3][4][5][6][7][8][9][10][11][12] és a kutatás honlapjáról lehet megismerni (http://www.eurohope.info). Az egyes diagnóziscso portok specifikus módszertani jellemzőit a témát ismer tető dolgozatokban közöljük.…”

“…A nemzetközi összehasonlító elemzéseket számos publi kációban [3][4][5][6][7][8][9][10][11][12] közöltük, a részletes publikációs jegy zék ugyancsak elérhető a EuroHOPE honlapján.…”

Risikojustering ved måling av predikert dødelighet etter hjerteinfarkt

“…Sosioøkonomiske forhold ble beskrevet ved variabler som har vist seg å korrelere med hjerteinfarktdødelighet (10,12,13) Hjerteinfarktpasienter får primaert trombolytisk behandling eller perkutan koronar intervensjon, et mindre antall åpen hjerteoperasjon (coronary artery bypass surgery, CABG). Pasientene ble klassifisert etter om de fikk trombolytisk eller annen medikamentell behandling eller perkutan koronar intervensjon eller åpen hjertekirurgi.…”

A Window on Geographic Variation in Health Care: Insights from EuroHOPE

“…Five specific diseases (acute myocardial infarction (AMI), breast cancer, hip fracture, stroke and infants born with very low birth weight (VLBW) and/or very low gestational age (VLGA) (further referred to as VLBW/VLGA infants) were selected to serve as case studies and for which countrywide patient data were collected in the participating countries (Finland, Hungary, Italy, 1 the Netherlands, Norway, Scotland and Sweden) Hagen et al, 2015aHagen et al, , 2015bMalmivaara et al, 2015;Medin et al, 2015;Numerato et al, 2015;Peltola et al, 2015;Smith et al, 2015). Five specific diseases (acute myocardial infarction (AMI), breast cancer, hip fracture, stroke and infants born with very low birth weight (VLBW) and/or very low gestational age (VLGA) (further referred to as VLBW/VLGA infants) were selected to serve as case studies and for which countrywide patient data were collected in the participating countries (Finland, Hungary, Italy, 1 the Netherlands, Norway, Scotland and Sweden) Hagen et al, 2015aHagen et al, , 2015bMalmivaara et al, 2015;Medin et al, 2015;Numerato et al, 2015;Peltola et al, 2015;Smith et al, 2015).…”

“…The EuroHOPE project was conceived to study such geographic variation in healthcare practice and in outcomes of care. Five specific diseases (acute myocardial infarction (AMI), breast cancer, hip fracture, stroke and infants born with very low birth weight (VLBW) and/or very low gestational age (VLGA) (further referred to as VLBW/VLGA infants) were selected to serve as case studies and for which countrywide patient data were collected in the participating countries (Finland, Hungary, Italy, 1 the Netherlands, Norway, Scotland and Sweden) Hagen et al, 2015aHagen et al, , 2015bMalmivaara et al, 2015;Medin et al, 2015;Numerato et al, 2015;Peltola et al, 2015;Smith et al, 2015). In addition, one study was carried out with the hospital as unit of analysis and including all diseases treated in the hospital (Kittelsen et al, 2015).…”