Impact of Socioeconomic Deprivation and Area of Residence on Access to Coronary Revascularization and Mortality After a First Acute Myocardial Infarction in Quebec
Impact of Socioeconomic Deprivation and Area of Residence on Access to Coronary Revascularization and Mortality After a First Acute Myocardial Infarction in Quebec
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DOI：
10.1016/j.cjca.2011.10.009
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发表时间：
2012-03-01
影响因子：
6.2
通讯作者：
Rinfret, Stephane
中科院分区：
文献类型：
--
作者：
Blais, Claudia;Hamel, Denis;Rinfret, Stephane
背景：众所周知，社会经济地位（SES）和居住地区会影响侵入性心脏手术的使用。低SES对急性心肌梗死（AMI）后的长期死亡率有不利影响。大多数数据来自私人医疗保健系统。我们的目的是评估SES和居住区对获得冠状动脉造影术，血运重建和死亡率的影响后，首次AMI在一个公共资助的医疗保健系统与高供应的导管facility.Methods：魁北克行政数据库被用来确定所有患者的首次AMI在1997年和2001年之间。社会经济地位的确定与人口剥夺指数，其中有两个维度：物质和社会。在比例风险生存回归分析中考虑了6个月血管造影、血管重建和1年死亡率，测量剥夺和居住地理区域的影响，并考虑了其他几个协变量。与最有特权的受试者相比，最物质和社会剥夺的患者1年内死亡的风险分别相对增加16%（95%置信区间[CI]，1.08-1.25）和13%（95% CI，1.05-1.21）。这种死亡率梯度不能用血管造影或血运重建的有意义的差异来解释。地理并没有影响获得血运重建procedure.Conclusions：尽管全民医疗保健系统，SES测量的物质和社会剥夺指数，有显着的不良影响，1年后的死亡率首次AMI。这些发现不能用冠状动脉造影或血运重建的低入路来解释。
Background: Socioeconomic status (SES) and area of residence are known to impact access to invasive cardiac procedures. Low SES adversely affects long-term mortality after acute myocardial infarction (AMI). Most of the data were derived from private healthcare systems. Our objectives were to evaluate the effects of SES and area of residence on access to coronary angiography, revascularization and mortality after a first AMI in a publicly-funded healthcare system with a high supply of catheterization facilities.Methods: Quebec administrative databases were used to identify all patients with a first AMI between 1997 and 2001. The SES was determined with the population deprivation index, which has 2 dimensions: material and social. Six-month access to angiography, revascularization and 1-year mortality were considered in proportional hazards survival regression analyses measuring the effect of deprivation and the geographical area of residence, accounting for several other covariates.Results: The study cohort consisted of 50,242 patients. The most materially and socially deprived patients had a 16% (95% confidence interval [CI], 1.08-1.25) and 13% (95% CI, 1.05-1.21) relative increased hazard of dying within 1 year respectively compared with the most privileged subjects. This mortality gradient could not be explained by meaningful differences in access to angiography or revascularization. Geography did not influence access to revascularization procedures.Conclusions: Despite universal healthcare system, SES measured with a material and social deprivation index, had significant adverse effect on 1-year mortality after a first AMI. Such findings were not explained by lower access to coronary angiography or revascularization.