Published in:
01-12-2007
Persistent Socio-economic Differences in Revascularization After Acute Myocardial Infarction Despite a Universal Health Care System—A Danish Study
Published in: Cardiovascular Drugs and Therapy | Issue 6/2007
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Background
Use of invasive revascularization [percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)] after acute myocardial infarction (AMI) in Denmark increased between 1996 and 2004. We investigated how this affected socioeconomic differences in their use.
Materials and methods
All patients aged 30–74 years in hospital for a first AMI in Denmark between 1996 and 2004 were included. Cox proportional hazard models were used to estimate the association between individual income (tertiles) and education (>12, 10–12 and <10 years) and time to revascularization within 6 months. Revascularization was stratified into CABG, acute PCI (within 2 days of admission) and non-acute PCI (after the third day).
Results
A total of 38,803 patients were included. In 1996–1998, 6.8% received CABG, 9.3% non-acute PCI and 2.4% acute PCI; in 2002–2004, these numbers were 11.8, 36.1 and 29.1%. CABG was more likely to be performed for patients with a high income [hazard ratio (HR), 1.18; 95% confidence interval (CI), 1.08–1.28] or a medium income (HR, 1.16; 95% CI, 1.07–1.25) than for those with a low income throughout the period. A similar income gradient was seen for non-acute PCI, but not for acute PCI, for which no gradient was seen. No educational gradient was found for CABG, and that for non-acute and acute PCI decreased during the period; by the end of the period, more patients with low than high education received acute PCI.
Conclusion
In the universal health care system of Denmark, income differences in CABG and non-acute PCI persisted, whereas no such differences were seen for acute PCI.