Socio-occupational differences in acute myocardial infarction case-fatality and coronary care in a northern Italian population

Cesana, Giancarlo; Ferrario, Marco; Gigante, Silvia; Sega, Roberto; Toso, Cláudia Eliane Ilgenfritz; Achilli, Felice

doi:10.1093/ije/30.suppl_1.s53

Cited by 30 publications

(29 citation statements)

References 19 publications

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“…[2][3][4] By contrast, very little inequality was apparent in small cohorts from the United Kingdom, Italy, and France. 5,29,30 The disparity highlights the health benefits of universal healthcare.…”

Section: Socioeconomic Inequalitymentioning

confidence: 99%

The UK National Health Service

Hawkins

Scholes

Bajekal

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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Background— Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity, or treatment. It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina. Methods and Results— This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30% to >60%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina. Conclusions— Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.

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Section: Socioeconomic Inequalitymentioning

confidence: 99%

The UK National Health Service

Hawkins

Scholes

Bajekal

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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“…[1][2][3] Despite the plea of political and health authorities, including the World Health Organization, to reduce health inequities, 4,5 comparatively little information is available on the potential of insurance systems to reduce inequalities in the treatment and outcome of specific diseases. In the United States, there is an ongoing debate on the pros and cons of a universal health coverage system.…”

mentioning

confidence: 99%

Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction

Danchin

Neumann

Tuppin

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Background-The type of medical coverage in patients with acute myocardial infarction (AMI) may affect their treatment and outcome. Methods and Results-We used the reimbursement database from the French National Health Insurance to determine the impact of full medical coverage (Couverture Médicale Universelle Complémentaire, CMUC), a free supplemental insurance for low-income earners Ͻ60 years of age, on treatment and outcomes of patients with AMI. The population comprised consecutive patients Ͻ60 years of age hospitalized for AMI from January to June 2006 in France. Of 4939 patients with AMI aged Ͻ60 years, 587 (12%) were on the CMUC. CMUC patients were younger, with more prior cardiovascular and comorbid conditions. CMUC and non-CMUC patients were admitted to the same types of institutions, including academic hospitals and private clinics. The use of cardiac catheterization and coronary interventions was similar (adjusted relative risk, 0.97; 95% confidence interval, 0.91-1.05; Pϭ0.45). In-hospital mortality was also comparable (3.1% versus 2.8%, Pϭ0.69). There was no difference in early use of secondary prevention medications after multivariate adjustment. At 30 months, survival and acute coronary syndrome-free survival were lower in CMUC patients (trend, not significant after adjustment). Long-term adherence to statin therapy was lower in CMUC patients (64% versus 77%; adjusted relative risk, 0.82; 95% confidence interval, 0.73-0.92). Conclusions-Free full coverage for socially deprived people levels inequalities in the acute and midterm treatment of AMI patients. However, full reimbursement per se is not sufficient to ensure optimal patient adherence to secondary prevention medications and may not be enough to prevent an excess of long-term events. (Circ Cardiovasc Qual Outcomes. 2011;4:619-625.)

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“…C oronary heart disease remains a leading cause of death in industrialised countries, but its incidence is not evenly distributed in the population. Socioeconomic gradients in the occurrence of myocardial infarction are well known, [1][2][3] and are related to disparate lifestyle risk factors; however, inequitable access to primary care and discrepancies in treatment and adherence may also be involved. After an acute coronary event, the efficacy of health care during both the acute phase and later medical follow up influences probability of survival.…”

mentioning

confidence: 99%

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy

Picciotto

Forastiére²,

Stafoggia³

et al. 2006

Journal of Epidemiology & Community Health

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Background: Socioeconomic gradients in the occurrence of myocardial infarction are well known, but few studies have examined socioeconomic disparities in post-infarction outcomes. The objective of this study was to explore relations of socioeconomic status with the incidence, treatment, and outcome of first coronary event in Rome, Italy, during the period 1998-2000, examining effect modification by gender. Methods: Subjects were Rome residents aged 35-84 years who died from first acute coronary event before reaching the hospital (n = 3470) or were hospitalised for first acute myocardial infarction (n = 8467). Area based deprivation status and patients' educational attainment were the exposure variables. The outcomes were: incidence of coronary event; recanalisation at the index hospitalisation and fatality within 28 days of hospitalisation; cardiac readmissions and fatality between 28 days and one year of index hospitalisation. Results: Incidence rates increased as area based deprivation status increased; the effect was stronger among women than among men (men RR = 1.40, 95%CI:1.30, 1.50, women RR = 1.78, 95%CI:1.60, 1.98, most compared with least deprived). Rates of recanalisation were significantly lower in the most deprived patients than in the least deprived (OR = 0.77, 95%CI:0.59, 0.99) and in the less educated than in the highly educated (OR = 0.73, 95%CI:0.58, 0.90). Associations of short term fatality with area based deprivation status and educational attainment were weak and inconsistent. However, neither deprivation status nor education was associated with one year outcomes. Conclusions: Area based deprivation status is strongly related to incidence of coronary events, and more so among women than among men. Deprivation status and educational attainment are weakly and inconsistently associated with short term fatality but seem not to influence one year prognosis of acute myocardial infarction. Deprived and less educated patients experience limited access to recanalisation procedures.

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Socio-occupational differences in acute myocardial infarction case-fatality and coronary care in a northern Italian population

Abstract: Combining these results with those obtained in other MONICA centres, it appears that further decreases in coronary mortality might be achieved through specific programmes addressed in particular to the reduction of out-of-hospital case-fatality in lower social classes.

Cited by 30 publications

References 19 publications

The UK National Health Service

The UK National Health Service

Impact of Free Universal Medical Coverage on Medical Care and Outcomes in Low-Income Patients Hospitalized for Acute Myocardial Infarction

Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy

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