Geographic and socioeconomic differences in access to revascularization following acute myocardial infarction
Giuliana De Luca1, Alessio Petrelli2,3, Tania Landriscina2
1Department of Economics, Statistics and Finance, University of Calabria, Rende (CS), Italy giuliana.deluca@unical.it.
Insights
Geographic and socioeconomic disparities in reperfusion for acute myocardial infarction (AMI) patients decreased over time. Access to life-saving procedures like percutaneous transluminal coronary angioplasty (PTCA) is improving, but disparities persist.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Healthcare access is influenced by geographic and socioeconomic factors.
- Disparities in accessing critical treatments for acute myocardial infarction (AMI) are a significant public health concern.
- This study investigated these disparities in Piedmont, Italy.
Purpose of the Study:
- To assess geographic and socioeconomic disparities in reperfusion procedures for AMI patients.
- To evaluate changes in these disparities over time.
- To inform strategies for equitable healthcare delivery.
Main Methods:
- Utilized a geographic information system (GIS) to geocode Coronary Care Units (CCUs).
- Calculated shortest drive times from CCUs to patients' residences.
- Employed log-binomial regression on AMI hospitalization data (2004-2012) to analyze Percutaneous Transluminal Coronary Angioplasty (PTCA) use in relation to drive time and socioeconomic status.
Main Results:
- 29% of AMI patients received revascularization within 2 days.
- Increased distance from CCUs correlated with decreased likelihood of receiving revascularization (RR 0.84 and 0.78 for longer distances).
- Lower educational attainment was associated with a lower relative risk of revascularization (RR 0.78), though both inequalities reduced over time.
Conclusions:
- Evidence shows a reduction in geographic and socioeconomic differences in revascularization for AMI patients.
- Healthcare access for life-threatening conditions should not be determined by location or socioeconomic status.
- Continued efforts are needed to ensure equitable treatment for all AMI patients.
Background:
Geographic and socioeconomic barriers may hinder fair access to healthcare. This study assesses geographic and socioeconomic disparities in access to reperfusion procedures in acute myocardial infarction (AMI) patients residing in Piedmont (Italy).
Methods:
Coronary Care Units (CCUs) were geocoded with a geographic information system (GIS) and the shortest drive time from CCUs to patients' residence was computed and categorized as 0 to <20, 20 to <40 and ≥40 min. Using data on AMI emergency hospitalizations in 2004-2012, we employed a log-binomial regression model to evaluate the relation between drive time and use of Percutaneous Transluminal Coronary Angioplasty (PTCA) occurring within 2 days after a hospitalization for an episode of AMI, and whether this relation varied depending on the period of hospitalization.
Results:
A total of 29% of all cases with a diagnosis of AMI (n = 66 097), were revascularized within 2 days from the index admission. The further AMI patients lived from CCUs, the less likely they were to receive revascularization: compared with distance <20 min, RRs were respectively 0.84 [95% CI 0.80-0.88] and 0.78 [95% CI 0.71-0.86]. Findings also showed that less educated people had a lower relative risk of being revascularized compared to more educated people (RR = 0.78; 95% CI = 0.74-0.82). Both inequalities have reduced in recent years.
Conclusion:
This study provides evidence of reduced geographical and socioeconomic differences in revascularization use over time. Geography and socioeconomic status should not determine the type of treatment received for life-threatening conditions such as AMI.
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