TY - JOUR
T1 - Socioeconomic Equity in the Receipt of In-Hospital Care and Outcomes in Australian Acute Coronary Syndrome Patients
T2 - The CONCORDANCE Registry
AU - Hyun, Karice
AU - Redfern, Julie
AU - Woodward, Mark
AU - D'Souza, Mario
AU - Shetty, Pratap
AU - Chew, Derek
AU - Kangaharan, Nadarajah
AU - Farshid, Ahmad
AU - Alford, Kevin
AU - Briffa, Tom
AU - Brieger, David
PY - 2018/12
Y1 - 2018/12
N2 - BackgroundSocioeconomic status (SES) is a social determinant of both health and receipt of health care services, but its impact is under-studied in acute coronary syndrome
(ACS). The aim of this study was to examine the influence of SES on
in-hospital care, and clinical events for patients presenting with an
ACS to public hospitals in Australia.MethodsData
from 9064 ACS patient records were collected from 41 public hospitals
nationwide from 2009 as part of the Cooperative National Registry of
Acute Coronary Syndrome Care (CONCORDANCE) registry. For this analysis,
we divided the cohort into four socioeconomic groups (based on postcode
of usual residence) and compared the in-hospital care provided and
clinical outcomes before and after adjustment for both patient clinical
characteristics and hospital clustering.ResultsPatients
were divided into four SES groups (from the most to the least
disadvantaged: 2042 (23%) vs. 2104 (23%) vs. 1994 (22%) vs. 2968 (32%)).
Following adjustments for patient characteristics, there were no
differences in the odds of receiving coronary angiogram, revascularisation, prescription of recommended medication, or referral to cardiac rehabilitation across the SES groups (p = 0.06,
0.69, 0.89 and 0.79, respectively). After adjustment for clinical
characteristics, no associations were observed for in-hospital and
cumulative death (p = 0.62 and p = 0.71, respectively).However,
the most disadvantaged group were 37% more likely to have a major
adverse cardiovascular event (MACE) than the least disadvantaged group
(OR (95% CI): 1.37 (1.1, 1.71), p = 0.02) driven by incidence of in-hospital heart failure.ConclusionsAlthough
there may be gaps in the delivery of care, this delivery of care does
not differ by patient's SES. It is an encouraging affirmation that all
patients in Australian public hospitals receive equal in-hospital care,
and the likelihood of death is comparable between the SES groups.
AB - BackgroundSocioeconomic status (SES) is a social determinant of both health and receipt of health care services, but its impact is under-studied in acute coronary syndrome
(ACS). The aim of this study was to examine the influence of SES on
in-hospital care, and clinical events for patients presenting with an
ACS to public hospitals in Australia.MethodsData
from 9064 ACS patient records were collected from 41 public hospitals
nationwide from 2009 as part of the Cooperative National Registry of
Acute Coronary Syndrome Care (CONCORDANCE) registry. For this analysis,
we divided the cohort into four socioeconomic groups (based on postcode
of usual residence) and compared the in-hospital care provided and
clinical outcomes before and after adjustment for both patient clinical
characteristics and hospital clustering.ResultsPatients
were divided into four SES groups (from the most to the least
disadvantaged: 2042 (23%) vs. 2104 (23%) vs. 1994 (22%) vs. 2968 (32%)).
Following adjustments for patient characteristics, there were no
differences in the odds of receiving coronary angiogram, revascularisation, prescription of recommended medication, or referral to cardiac rehabilitation across the SES groups (p = 0.06,
0.69, 0.89 and 0.79, respectively). After adjustment for clinical
characteristics, no associations were observed for in-hospital and
cumulative death (p = 0.62 and p = 0.71, respectively).However,
the most disadvantaged group were 37% more likely to have a major
adverse cardiovascular event (MACE) than the least disadvantaged group
(OR (95% CI): 1.37 (1.1, 1.71), p = 0.02) driven by incidence of in-hospital heart failure.ConclusionsAlthough
there may be gaps in the delivery of care, this delivery of care does
not differ by patient's SES. It is an encouraging affirmation that all
patients in Australian public hospitals receive equal in-hospital care,
and the likelihood of death is comparable between the SES groups.
KW - Acute coronary syndrome
KW - Socioeconomic status
KW - In-Hospital care
KW - Clinical events
UR - http://www.scopus.com/inward/record.url?scp=85031734667&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2017.08.019
DO - 10.1016/j.hlc.2017.08.019
M3 - Article
VL - 27
SP - 1398
EP - 1405
JO - Heart, Lung and Circulation
JF - Heart, Lung and Circulation
SN - 1443-9506
IS - 12
ER -