Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non‐Aboriginal patients with acute ischaemic heart disease in Western Australia

BMC Cardiovascular Disorders

Research Article

Peter L Thompson¹  Matthew W Knuiman²  Tom G Briffa²  Michael ST Hobbs²  Frank M Sanfilippo²  Derrick Lopez³  John A Woods³  Sandra C Thompson³  Judith M Katzenellenbogen⁴ 

[1]School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Nedlands, Western Australia, Australia

[2]School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia

[3]Western Australian Centre for Rural Health, The University of Western Australia, Crawley, Western Australia, Australia

[4]Western Australian Centre for Rural Health, The University of Western Australia, Crawley, Western Australia, Australia

[5]School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia

关键词: Oceanic ancestry group;    Ischaemic heart disease;    Myocardial infarction;    Healthcare Disparities;    Rural Hospitals;    Health Insurance;    Coronary angiography;   

DOI  :  10.1186/1471-2261-14-58

 received in 2013-09-24, accepted in 2014-04-24,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundAboriginal people have a disproportionately higher incidence rate of ischaemic heart disease (IHD) than non-Aboriginal people. The findings on Aboriginal disparity in receiving coronary artery procedures are inconclusive. We describe the profile and transfers of IHD patients admitted to rural hospitals as emergency admissions and investigate determinants of transfers and coronary angiography.MethodsPerson-linked hospital and mortality records were used to identify 28-day survivors of IHD events commencing at rural hospitals in Western Australia. Outcome measures were receipt of coronary angiography, transfer to a metropolitan hospital, and coronary angiography if transferred to a metropolitan hospital.ResultsCompared to non-Aboriginal patients, Aboriginal patients with IHD were more likely to be younger, have more co-morbidities, reside remotely, but less likely to have private insurance. After adjusting for demographic characteristics, Aboriginal people with MI were less likely to be transferred to a metropolitan hospital, and if transferred were less likely to receive coronary angiography. These disparities were not significant after adjusting for comorbidities and private insurance. In the full multivariate model age, comorbidities and private insurance were adversely associated with transfer to a metropolitan hospital and coronary angiography.ConclusionDisparity in receiving coronary angiography following emergency admission for IHD to rural hospitals is mediated through the lower likelihood of being transferred to metropolitan hospitals where this procedure is performed. The likelihood of a transfer is increased if the patient has private insurance, however, rural Aboriginal people have a lower rate of private insurance than their non-Aboriginal counterparts. Health practitioners and policy makers can continue to claim that they treat Aboriginal and non-Aboriginal people alike based upon clinical indications, as private insurance is acting as a filter to reduce rural residents accessing interventional cardiology. If health practitioners and policy makers are truly committed to reducing health disparities, they must reflect upon the broader systems in which disparity is perpetuated and work towards a systems improvement.

【 授权许可】

CC BY   
© Lopez et al.; licensee BioMed Central Ltd. 2014