Impact of capacity on access to invasive coronary angiography by patients of different socio-economic status

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 probit 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. 

About the presenter’s visit

Jongsay Yong will be visiting the School of Economics on 27 November 2019.  While here he will be using room 520A Colin Clark Building.  If you would like to meet with him or have lunch or dinner with him please contact A/Prof Valentin Zelenyuk who will be his host while at The University of Queensland.  A/Prof Zelenyuk can be contacted on v.zelenyuk@uq.edu.au.