Clinical investigationsUniversal health insurance coverage does not eliminate inequities in access to cardiac procedures after acute myocardial infarction☆
Section snippets
Study population
We used the Quebec Discharge Summary database to identify all patients admitted with a diagnosis of a first AMI between January 1, 1985, to December 31, 1995. As previously described, patients were identified for inclusion in the AMI cohort if hospitalized for a main diagnosis of AMI (ICD9 code 410) for the first time as ascertained by the absence of a hospitalization for AMI for at least the previous 3 years.9 This database was linked to the physicians' claims database to obtain information on
Study population
Between January 1, 1985, and December 31, 1995, a total of 85,435 patients were admitted with a first AMI to an acute care hospital in the province of Quebec. These patients represent close to the totality of individuals with a first AMI in the province of Quebec. Twenty-seven percent of patients had missing or invalid postal codes or SES data were not available in the 1991 census. These patients were from low populated areas. These patients were excluded from the current analysis, leaving
Discussion
We found that in the universal health care system of Canada, access to cardiac catheterization post-AMI varied according to SES both in 1989 and 1994. After adjustment for the available individual-level predictors of use of cardiac catheterization, the variability was mostly explained by SES variables. As a result, the probability of cardiac catheterization for a patient living in a low SES area was considerably lower than that of a patient in a high SES area, independent of age, comorbidities,
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Dr Pilote is an Investigator of the Canadian Institutes of Health Research.
Supported in part by the Fonds de la recherche en santé du Québec (grant 990726-104).