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Effects of morbidity, age, gender and region on percutaneous transluminal coronary angioplasty (PTCA) utilisation
R Strauss1, C Pfeifer, V Muhlberger
1Ludwig-Boltzmann-Institute for Epidemiology and Research on Health Systems, University of Innsbruck, Austria.
Insights
Percutaneous Transluminal Coronary Angioplasty (PTCA) use increased from 1993-1995, but women and older individuals received fewer interventions. Geographical disparities in PTCA application were noted, unrelated to patient morbidity.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Coronary heart disease, including myocardial infarction and angina pectoris, affects a significant portion of the population.
- Percutaneous Transluminal Coronary Angioplasty (PTCA) is a key intervention for managing coronary artery disease.
- Understanding trends in PTCA utilization is crucial for equitable healthcare delivery.
Purpose of the Study:
- To analyze changes in PTCA application rates concerning patient demographics (age, gender) and geographical variations.
- To examine the relationship between patient morbidity and the geographical distribution of PTCA procedures.
- To identify disparities in PTCA utilization across different population subgroups and regions in Austria.
Main Methods:
- A retrospective record linkage study was conducted.
- Data from all 156 Austrian hospitals and cardiology centers performing the Minimum Basic Data Set (MBDS) were analyzed.
- The study included all Austrian residents diagnosed with myocardial infarction, coronary heart disease, or angina pectoris between 1993 and 1995.
Main Results:
- The PTCA intervention rate increased from 33% in 1993 to 40% in 1995.
- Significant gender disparities were observed, with men receiving PTCA more frequently than women (OR=2.8).
- Marked geographical differences in PTCA rates were found, but these did not correlate with morbidity rates.
Conclusions:
- PTCA utilization varied significantly by age, gender, and region, with women and older populations receiving fewer interventions.
- The study highlights a need for further investigation into supply-side, economic, and social factors influencing PTCA access.
- Public health strategies are recommended to ensure equitable PTCA utilization across the Austrian population.
Objectives:
To investigate changes in the use of PTCA application in respect to morbidity, gender, region and age, and to investigate the morbidity as related to geographical variation.
Study Design:
Retrospective record linkage study.
Setting:
All hospitals and cardiological centres (n = 156) which performed the Minimum Basic Data Set (MBDS).
Patients:
All Austrian residents who were diagnosed for myocardial infarction, coronary heart disease or angina pectoris in 1993-1995 (1993: n = 73.077; 1994: n = 80.173; 1995: n = 84.896).
Measurements And Main Results:
The intervention rate (IR = PTCA/indication) increased from 0.03-0.04 (33%) between 1993 and 1995 with differences in genders (males: 24%, females: 27.7%) and regions (Vorarlberg: -7.5%, Burgenland: 65.3%). Male morbidity started to increase at about 60 y and female morbidity at about 70 y. Morbidity as a demand factor did not correlate with PTCA application. The intervention rate was significantly lower for females in Austria in general (P < 0.001) as it was in every Federal State (P < 0.001). This pattern was constant during 1993-1995 with the highest difference in Salzburg and the lowest in Styria. Austrian men were about three times more likely to have received PTCA application than women (crude Odds Ratio = 2.8, 95% CI = 2.6-3, P-value < 0.001). Logistic regression modelling revealed age as main confounder (adjusted Odds Ratio = 1.36, 95% CI = 1.31-1.42, P < 0.001). The > or = 5% intervention rate peak was between 30-75 y for males and between 30-65 y for females whereas morbidity of > or = 1% started for males at about 50 y and for females at about 60 y. Marked geographical differences of the intervention rate were observed (Upper Austria, Salzburg IR = 0.07, Styria IR = 0.02) but could not be explained by the demand factor morbidity (Pearson's correlation coefficients 1993: 0.039, P = 0.71; 1994: 0.155, P = 0.133; 1995: 0.087, P = 0.399).
Conclusions:
The highest intervention rates were in the age groups with the lowest morbidity. Women received significantly fewer interventions than men by age and region. The demographic strata with lowest use rate were women aged 64 y and more. Marked geographical differences of PTCA application were stated but could not be explained by the demand factor morbidity. Further studies on supply factors as well as on economic and social factors are needed in order to develop public health strategies to guarantee equal utilisation rates for the whole Austrian population.
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