Disparities in equity and access for hospitalised atherothrombotic disease
Emily R. Atkins A B , Elizabeth A. Geelhoed A , Lee Nedkoff A and Tom G. Briffa AA School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. Email: lee.nedkoff@uwa.edu.au, tom.briffa@uwa.edu.au, elizabeth.geelhoed@uwa.edu.au
B Corresponding author. Email: emily.atkins@uwa.edu.au
Australian Health Review 37(4) 488-494 https://doi.org/10.1071/AH13083
Submitted: 26 April 2012 Accepted: 17 June 2013 Published: 21 August 2013
Journal Compilation © AHHA 2013
Abstract
Objective. This study of equity and access characterises admissions for coronary, cerebrovascular and peripheral arterial disease by hospital type (rural, tertiary and non-tertiary metropolitan) in a representative Australian population.
Methods. We conducted a descriptive analysis using data linkage of all residents aged 35–84 years hospitalised in Western Australia with a primary diagnosis for an atherothrombotic event in 2007. We compared sociodemographic and clinical features by atherothrombotic territory and hospital type.
Results. There were 11 670 index admissions for atherothrombotic disease in 2007 of which 46% were in tertiary hospitals, 41% were in non-tertiary metropolitan hospitals and 13% were in rural hospitals. Coronary heart disease comprised 72% of admissions, followed by cerebrovascular disease (19%) and peripheral arterial disease (9%). Comparisons of socioeconomic disadvantage reveal that for those admitted to rural hospitals, more than one-third were in the most disadvantaged quintile, compared with one-fifth to any metropolitan hospital.
Conclusions. Significant differences in demographic characteristics were evident between Western Australian tertiary and non-tertiary hospitals for patients hospitalised for atherothrombotic disease. Notably, the differences among tertiary, non-tertiary metropolitan and rural hospitals were related to socioeconomic disadvantage. This has implications for atherothrombotic healthcare provision and the generalisation of research findings from studies conducted exclusively in the tertiary metropolitan hospitals.
What is known about the topic? Equity and access to hospital care for atherothrombotic disease in a geographically diverse population is poorly characterised. National data show that both fatal and non-fatal coronary heart disease and non-fatal stroke hospitalisations increase with remoteness. Fatal in-hospital stroke is greatest in major cities, whereas peripheral arterial disease hospitalisations are greatest in the inner and outer regional areas.
What does this paper add? This study demonstrates that around 13% of atherothrombotic events were treated in rural hospitals with in-hospital case fatality higher than in tertiary and non-tertiary metropolitan hospitals. A greater proportion of atherothrombotic disease cases treated in rural hospitals were in the most disadvantaged Socioeconomic Indices For Area group.
What are the implications for practitioners? It is important to consider differences in disadvantage when generalising results of studies generated from tertiary hospital data to non-tertiary metropolitan and rural patients.
Additional keywords: cardiovascular disease, coronary heart disease, hospital, peripheral vascular disease, stroke, Western Australia.
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