Objective: assessing the equity in the access to the percutaneous transluminal coronary angioplasty (PTCA) and in its time trend among patients with ST-elevation acute myocardial infarction.
Design: observational study based on regional administrative data: Hospital Discharge Registry, Health Registry, and 2001 Census data. Two indexes were used as deprivation measure: deprivation status at small area level (as proxy of the individual deprivation) and deprivation status at Local Health Agency level. The residence in a mountain municipality was used as extra measure of contextual deprivation.
Setting and participants: patients with first emergency hospital admission for acute myocardial infarction (AMI) with ST-elevation, resident in Tuscany Region (Central Italy) and hospitalized during the period 2001-2008.
Main outcome measures: relative risk (RR) of the PTCA utilization.
Results: multivariate analysis by multilevel multiple logistic regression showed a significant lower PTCA utilization in females (RR: 0.91, p <0.0001), in patients with high deprivation status at Local Health Agency level (RR: 0.71, p <0.0001), in residents in a mountain municipality (RR: 0.90, p <0.0001), and in patients with comorbidity (RR: 0.98, p =0.006; RR: 0.87, p <0.0001; RR: 0.69, p <0.0001 for Charlson comorbidity index equal to 1, 2, ≥3, respectively). The PTCA utilization over time has grown significantly (p <0.0001), from 26.6% in 2001 to 57.4% in 2008. This increase was more pronounced in patients with high deprivation status at Local Health Agency level (RR: 4.01, p <0.0001 for year 2008 vs. 2001), with consequent reduction of the initial differential with respect to patients with low deprivation status at Local Health Agency level (RR: 0.40, p <0.0001 in 2001 and RR: 0.93, p =0.114 in 2008). However, the differential associated with gender and residence in a mountain municipality persisted over time.
Discussion: In Tuscany during the period 2001-2008 a significant reduction of the differential in the PTCA utilization associated with the deprivation status at Local Health Agency level was observed. This finding could be explained by the diffusion and organization of suitable invasive cardiology units in the region, the organizational models of care, the different propensity to the PTCA utilization by the referral hospitals.