Ancona C, Agabiti N, Forastiere F, Arcà M, Fusco D, Ferro S, Perucci C A
Agency for Public Health-Lazio, Italy.
J Epidemiol Community Health. 2000 Dec;54(12):930-5. doi: 10.1136/jech.54.12.930.
To evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in accordance with need. To estimate the association between SES and mortality occurring 30 days after CABG surgery.
Individual socioeconomic index assigned with respect to the characteristics of the census tract of residence (level I = highest SES; level IV = lowest SES). Comparison of age adjusted hospital admission rates of ischaemic heart disease (IHD) and CABG surgery among four SES groups. Retrospective cohort study of all patients who underwent CABG surgery during 1996-97.
Rome (2 685 890 inhabitants) and the seven cardiac surgery units in the city.
All residents in Rome aged 35 years or more. A cohort of 1875 CABG patients aged 35 years or more.
Age adjusted hospitalisation rates for CABG and IHD and rate of CABG per 100 IHD hospitalisations by SES group, taking level I as the reference group. Odds ratios of 30 day mortality after CABG surgery, adjusted for age, gender, illness severity at admission, and type of hospital where CABG was performed.
People in the lowest SES level experienced an excess in the age adjusted IHD hospitalisation rates compared with the highest SES level (an excess of 57% among men, and of 94% among women), but the rate of CABG per 100 IHD hospitalisations was lower, among men, in the most socially disadvantaged level (8.9 CABG procedures per 100 IHD hospital admissions in level IV versus 14.1 in level I rate ratio= 0.63; 95% CI 0.44, 0.89). The most socially disadvantaged SES group experienced a higher risk of 30 day mortality after CABG surgery (8. 1%) than those in the highest SES group (4.8%); this excess in mortality was confirmed even when initial illness severity was taken into account (odds ratio= 2.89; 95% CI 1.44, 5.80).
The universal coverage of the National Health Service in Italy does not guarantee equitable access to CABG surgery for IHD patients. Factors related to SES are likely to influence poor prognosis after CABG surgery.
评估冠状动脉搭桥术（CABG）是否根据需求在不同社会经济地位（SES）群体中平等提供。估计SES与CABG术后30天死亡率之间的关联。
根据居住普查区的特征分配个体社会经济指数（I级=最高SES；IV级=最低SES）。比较四个SES组中缺血性心脏病（IHD）和CABG手术的年龄调整住院率。对1996 - 1997年期间接受CABG手术的所有患者进行回顾性队列研究。
罗马（2685890名居民）及该市的七个心脏外科单位。
罗马所有35岁及以上居民。一组1875名35岁及以上的CABG患者。
CABG和IHD的年龄调整住院率以及按SES组划分的每100例IHD住院的CABG率，以I级作为参照组。CABG术后30天死亡率的比值比，根据年龄、性别、入院时疾病严重程度以及进行CABG手术的医院类型进行调整。
与最高SES水平相比，最低SES水平的人群年龄调整后的IHD住院率更高（男性高出57%，女性高出94%），但每100例IHD住院的CABG率在社会最弱势水平的男性中较低（IV级每100例IHD住院中有8.9例CABG手术，I级为14.1例；率比 = 0.63；95%CI 0.44，0.89）。社会最弱势的SES组在CABG术后30天死亡率方面比最高SES组更高（8.1%）；即使考虑到初始疾病严重程度，这种死亡率过高的情况仍然得到证实（比值比 = 2.89；95%CI 1.44，5.80）。
意大利国家医疗服务体系的全民覆盖并不能保证IHD患者公平获得CABG手术。与SES相关的因素可能会影响CABG术后的不良预后。
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