Jongsay Yong, Melbourne Institute / Socioeconomic status, access to invasive coronary angiography, and survival probability of acute myocardial infarction patients

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Title: Socioeconomic status, access to invasive coronary angiography, and survival probability of acute myocardial infarction patients

Abstract: This paper examines access to invasive coronary angiography (ICA) of two types of acute myocardial infarctions (AMI): ST-elevation myocardial infarctions (STEMI) and Non-ST-elevation myocardial infarctions (NSTEMI). We examine whether socio-economic status (SES) of patients affects access to ICA and subsequent survival. We focus on the catheterisation capacity of admitting hospitals on admission of an AMI episode. Although by best-practice guidelines both STEMI and NSTEMI patients should receive ICA, they differ in urgency: STEMI requires more urgent ICA compared to NSTEMI. We examine STEMI and NSTEMI hospital admission episodes occurring in Victoria during a seven-year period (2004/05 – 2011/12). The sample consists of 13,468 STEMI and 42,167 NSTEMI of first-time AMI admissions occurring in 144 hospitals. Catheterization capacity of hospitals on admission is measured using the maximum number of daily catheterization procedures performed during the previous 14 days by the admitting hospital. SES is measured using private insurance status, rurality and SEIFA index, an area-based socio-economic disadvantage index. We jointly model the probability of patients admitting to a catheterization-capable hospital, receiving ICA, and surviving 30 days post discharge using a recursive system of equations. The results suggest that the SES plays an important role in affecting the access to ICA and survival probability of AMI patients. We find that the probability of receiving ICA is significantly lower for patients in SES disadvantaged areas than in advantaged areas, and for private than public patients.

Presenter: Jongsay Yong, Melbourne Institute

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