Abstract
As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P<.001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P<.001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P<.001) compared to urban patients. Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.
Highlights
Inequalities in healthcare lead to growing costs, poverty, disability, and death, and have grave social repercussions and profound economic consequences.[1]
ST-elevation myocardial infarction (STEMI) is the most serious type of acute myocardial infarction as it causes fullthickness myocardial necrosis after the related coronary artery is blocked, which induces an elevation of the STsegment of the electrocardiogram (ECG)
Baseline Characteristics A total of 376 patients diagnosed with STEMI in Chuxiong Prefecture before the implementation of the STEMI network comprising 280 males with mean age 58.59 (SD 11.85) years and 96 females with mean age 65.76 (SD 10.43) years were analysed
Summary
Inequalities in healthcare lead to growing costs, poverty, disability, and death, and have grave social repercussions and profound economic consequences.[1]. ST-elevation myocardial infarction (STEMI) is the most serious type of acute myocardial infarction as it causes fullthickness myocardial necrosis after the related coronary artery is blocked, which induces an elevation of the STsegment of the electrocardiogram (ECG). Heart tissue begins to die within 15-30 minutes of loss of blood supply,[5] and complete necrosis of myocardial cells at risk can take place over 3-4 hours,[6] which means there is a finite period of time to rescue a STEMI patient from ischaemic myocardial infarction. Prompt percutaneous coronary intervention (PCI) and fibrinolysis are the two main strategies of reperfusion therapy.[7] there are many steps in the whole process, from symptom onset to patient presentation, diagnosis of STEMI and emergency reperfusion
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