Academic journal article Australian Health Review

Disparities in Equity and Access for Hospitalised Atherothrombotic Disease

Academic journal article Australian Health Review

Disparities in Equity and Access for Hospitalised Atherothrombotic Disease

Article excerpt

Introduction

Ischaemic cardiovascular or atherothrombotic disease (ATD), involving the coronary, cerebral and peripheral arterial territories, is a leading national health priority in Australia. It is a dominant cause of death accounting for 32% of national statistics in 20101 and is more costly than any other single disease.2 In 2009-10, $7.9 billion was spent on all cardiovascular disease (CVD), approximately half of which was for hospitalisations. 2 In 2007 in Western Australia's (WA's) population of 2.1 million (10% of the Australian population), 68 000 people were estimated to have CVD,3 with the prevalence increasing with geographic remoteness.4 This latter pattern is reflected in the age-standardised national hospitalisation and death rates for coronary heart disease (CHD), and for hospitalisations for cerebrovascular disease (CeVD) and peripheral arterial disease (PAD).4

Equity and access to urban versus non-urban hospitals for ATD care at a population level is poorly understood. Provision of hospital services is typically measured around presentation to large metropolitan tertiary teaching hospitals, which could limit the generalisability of the findings. Further, there is poor sociodemographic and clinical characterisation stratified by hospital services and locality of patients admitted with ischaemic CVD. The authors have not found descriptions of all ATD hospitalisations by metropolitan or rurality in other jurisdictions nationally and internationally. The objective of the present study was to characterise admissions for an atherothrombotic event in the major arterial territories among men and women aged 35-84 years to tertiary, non-tertiary metropolitan and rural hospitals in WA during 2007.

Methods

Design

This study was a descriptive analysis of a cohort identified using administrative health data linkage. The cohort consisted of all residents aged 35-84 years hospitalised in WA with a primary diagnosis for ATD identified from International Classification of Disease codes in 2007 (Table 1).

In Perth, acute health services are provided by three large public tertiary hospitals and a mix of public and private metropolitan hospitals. Hospital services in rural (inner and outer regional, remote and very remote) WA are mostly public, with a private hospital in each of the three larger regional cities of Geraldton (430 km from Perth), Bunbury (170 km from Perth) and Mandurah (70 km from Perth). The WA population is considered representative of the Australian population in terms of socioeconomic and demographic characteristics.5 Approval for this study was obtained from the Human Research Ethics Committees at theWADepartment of Health and The University of Western Australia.

Dataset

The dataset used for this study was obtained from the Hospital Morbidity Data Collection (HMDC) and death registrations. The HMDC is a collection of data from all public and private hospitals in WA managed by the WA Data Linkage System (WADLS).6 Death registrations included only deaths registered in WA. Linkage of administrative health data was performed by the Data Linkage Branch at the Department of Health,WAusing probabilistic matching with clerical review, with linkage accuracy estimated at 99.89%.7

Index admission was defined as the patient's first ATD hospitalisation in WA in 2007. Comparisons by arterial territory were only for the index admission. For example, a person whose index admission in 2007 was an acute myocardial infarction was only included in the CHD category, even if they had a history before 2007 of PAD, CeVD or CHD. The disease categories for index admissions were mutually exclusive.

Comorbidity was measured individually and grouped for comparative purposes. First, we considered the presence or absence of diabetes, hypertension, chronic kidney disease, atrial fibrillation, heart failure, chronic lung disease and cancer in any one of 21 diagnostic fields for any hospitalisation during the preceding 15 years of the index ATD presentation. …

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