Disparities in Revascularization Rates after Acute Myocardial Infarction between Aboriginal and Non-Aboriginal People in Australia
Background—This study examined revascularization rates after acute myocardial infarction (AMI) for Aboriginal and non-Aboriginal patients sequentially controlling for admitting hospital and risk factors.
Methods and Results—Hospital data from the state of New South Wales, Australia (Jul00-Dec08) were linked to mortality data (Jul00-Dec09). The study sample were all people aged 25 to 84 years admitted to public hospitals with a diagnosis of AMI (n=59 282). Single level and multilevel Cox regression was used to estimate rates of revascularization within 30 days of admission. A third (32.9%) of Aboriginal AMI patients had a revascularization within 30 days compared with 39.7% non-Aboriginal patients. Aboriginal patients had a revascularization rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission and AMI type (adjusted hazard ratio (AHR) 0.63, 95% CI 0.57-0.70). Within the same hospital, however, Aboriginal patients had a revascularization rate 18% lower (AHR 0.82, 95% CI 0.74-0.91). Accounting for comorbidities, substance use and private health insurance further explained the disparity (AHR 0.96, 0.87-1.07). Hospitals varied markedly in procedure rates, and this variation was associated with hospital size, remoteness and catheterization laboratory facilities.
Conclusions—Aboriginal Australians were less likely to have revascularization procedures after AMI than non-Aboriginal Australians, and this was largely explained by lower revascularization rates at the hospital of first admission for all patients admitted to smaller regional and rural hospitals, a higher comorbidity burden for Aboriginal people, and to a lesser extent a lower rate of private health insurance among Aboriginal patients.
- Received July 17, 2012.
- Accepted December 27, 2012.
- Copyright © 2013, Circulation