Socioeconomic Status, Access to Health Care, and Outcomes After Acute Myocardial Infarction in Canada's Universal Health Care System

BACKGROUND: There is a debate as to whether universal drug coverage confers similar access to care at all socioeconomic status (SES) levels. Experiences in Canada may bring light to questions raised regarding access. OBJECTIVE: To assess associations between SES and access to cardiac care and outcomes in Canada's universal health care system. DESIGN, SETTING, AND PATIENTS: All patients admitted to acute care hospitals in Quebec (QC), Ontario (ON), and British Columbia (BC), between 1996 and either 2000 (QC) or 2001 (ON, BC) with acute myocardial infarction, were identified using provincial government administrative databases (n = 145,882). MEASUREMENTS: Variables representing SES grouped at the census area level were examined in association with use of cardiac medications and procedures, survival, and readmission, while adjusting for individual-level variables. A Bayesian hierarchical logistic regression model was used to account for the nested structure of the data. RESULTS: Despite provincial variations in SES and drug reimbursement policies, there were generally no associations between the SES variables and access to cardiac medications or invasive cardiac procedures. The few exceptions were not consistent across SES indicators and/or provinces. Similarly, the only observed effect of SES on clinical outcomes was in BC, where there was increased 1-year mortality among patients living in less-affluent regions (adjusted odds ratios per standard deviation change in proportion of low-income households, 95% Bayesian credible intervals, QC: 1.09, 0.96-1.25; ON: 1.02, 0.95-1.08; and BC: 1.18, 1.09-1.28). CONCLUSIONS: These results suggest that intermediary factors other than SES, such as cardiovascular risk factors, likely account for observed "wealth-health" gradients in Canada. Implementation of a universal drug coverage policy could decrease socioeconomic disparities in access to health care

Environmental health · Geography · Health care · Household income · Logistic regression · Myocardial infarction · Odds · Odds ratio · Political science · Population · Reimbursement · Socioeconomic status · Demography · Health disparities and outcomes · Healthcare Policy and Management · Healthcare Systems and Reforms · Internal Medicine · Medicine · Gerontology

• Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Readmission Rates

  Open Access•Grant R Martsolf, Marguerite L Barrett et al.•INQUIRY The Journal of Health…•2016

  Incluir item

• Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction

  Open Access•Randi E Foraker, Kathryn M Rose et al.•BMC Public Health•2010

  Incluir item

• Universal health care no guarantee of equity

  Open Access•Rosemary J Korda, Rosemary Korda et al.•BMC Public Health•2009

  Incluir item

• Breast cancer care in the Canada and the United States

  Open Access•Kevin M Gorey, Isaac Luginaah et al.•Health & Place•2009

  Incluir item

• Multimorbidity and Socioeconomic Deprivation among Older Adults

  Andrew Wister, Leah Rosenkrantz et al.•Journal of Aging and Environment•2020

  Incluir item

• The association of socioeconomic disadvantage with postoperative complications after major elective cardiovascular surgery

  Open Access•Nera Agabiti, Giulia Cesaroni et al.•Journal of Epidemiology and…•2008

  Incluir item

• Health Status, Neighborhood Socioeconomic Context, and Premature Mortality in the United States

  Chyke A Doubeni, Mario Schootman et al.•American Journal of Public Health•2012

  Incluir item

• Social class and coronary heart disease.

  Gwen Rose, Michael Marmot et al.•Heart•1981

  Incluir item

• Effects of Socioeconomic Status on Access to Invasive Cardiac Procedures and on Mortality after Acute Myocardial Infarction

  David A Alter, C David Naylor et al.•New England Journal of Medicine•1999

  Incluir item

• Socioeconomic Inequalities in Health

  Nancy E Adler•JAMA•1993

  Incluir item

• Assessing ecologic proxies for household income

  Open Access•Cam Mustard, Shelley Derksen et al.•Health & Place•1999

  Incluir item

• Socioeconomic status and birth weight

  Nicholas V Hoang, N Spencer et al.•Journal of Epidemiology and…•1999

  Incluir item

• Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish Monica population, 1982–1992

  Merete Osler, Lars Ulrik Gerdes et al.•Journal of Epidemiology and…•2000

  Incluir item

• Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality

  Gregory D Smith, Carole Hart et al.•Journal of Epidemiology and…•1998

  Incluir item

• Is enumeration district level an improvement on ward level analysis in studies of deprivation and health

  Roy Carr‐hill, R Carr-Hill et al.•Journal of Epidemiology and…•1995

  Incluir item

• Socioeconomic status and health

  Nancy E Adler, Thomas G Boyce et al.•American Psychologist•1994

  Incluir item