SOCIOECONOMIC INEQUALITIES IN QUALITY-OF-CARE AND OUTCOMES AMONG PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN HONG KONG
Author(s)
Yan BP1, Chan LL1, Chan CK1, To OT1, Wong MC1, Reid C2, Lee VW1
1The Chinese University of Hong Kong, Shatin, Hong Kong, 2Monash University, Melbourne, Australia
OBJECTIVES: Socioeconomic status has been associated with adverse cardiovascular outcomes. We aim to evaluate the impact of socioeconomic status on characteristics and outcomes of patients undergoing percutaneous coronary intervention (PCI) in Hong Kong. METHODS: We retrospectively analyzed 3300 patients undergoing PCIs between Sep 2009 and Dec 2013 at a tertiary academic institution. Low socioeconomic status (LSES) was defined by recipient of the Comprehensive Social Security Assistance (CSSA) Scheme which provides a safety net for those who cannot support themselves financially based on total household income and asset tests. Baseline characteristics and 12 month clinical outcomes including death, myocardial infarction (MI), target vessel revascularization (TVR) and composite major adverse cardiac events (MACE, composite of death, MI and TVR) were compared between LSES and non-LSES patients. Independent predictors of 12 month MACE were identified using multivariate analysis. RESULTS: Of 3,300 patients, 19.2% (n=635) were of LSES with mean age of 64±10.9 years and 75.6% male. LSES patients had high rates of co-morbidities including smoking, renal failure, history of MI, heart failure, previous PCI compared to non-LSES patients (all p<0.01). LSES patients had higher rates of death (5.1% vs. 3.2%), MI (2.2% vs. 0.6%), TVR (2.2% vs. 1.1%) and MACE (9.8% vs. 4.8%, all p<0.01) at 12 months. LSES was an independent predictor of 12-month MACE (Odds Ratio [OR] 1.45, 95% confidence interval [CI] 0.99-2.12, p=0.05). The use of drug-eluting stents (DES) was the only independent predictor of freedom-from-MACE at 12 month (OR 0.48, 95%CI 0.35-0.66, p<0.01). However, DES is only used in 20.6% of LSES patients compared to 80.7% of non-LSES patients (p<0.01). CONCLUSIONS: Among patients undergoing PCI, a low socioeconomic status is associated with a higher prevalence of cardiovascular risk factors and adverse outcomes but less effective therapy such as bare-metal stents.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PMD18
Topic
Epidemiology & Public Health
Disease
Cardiovascular Disorders