Australian Centre for Economic Research on Health, The Australian National University, Australia.
Soc Sci Med. 2011 Jan;72(2):224-9. doi: 10.1016/j.socscimed.2010.11.002. Epub 2010 Nov 23.
This paper examines socioeconomic lags in the diffusion of high technology health care, focusing on the diffusion of coronary procedures in people with ischaemic heart disease. Using linked hospital and mortality data, we studied patients admitted to Western Australian hospitals with a first admission for acute myocardial infarction between 1989 and 2003 (n = 27,209). An outcome event was the receipt, within a year, of a coronary procedure-angiography, angioplasty and/or coronary artery bypass surgery (CABG). Socioeconomic status (SES) was assigned to each individual using the SEIFA Index of Disadvantage. Cox regression was used to model the association between SES and procedure rates in five consecutive three-year time periods. Angiography and CABG showed socioeconomic lags in diffusion, with rates peaking earlier in higher SES patients, such that the inequality patterns were consistent with the inverse equity hypothesis. The evidence for a lag in diffusion for angioplasty was weaker. Overall, that there is some evidence for a lag in diffusion of health technology indicates that it is essential to consider trends over time when examining the equity impact of health technologies.
本文考察了高医疗技术扩散的社会经济滞后现象，重点关注缺血性心脏病患者中冠状动脉手术的扩散。我们使用了关联的医院和死亡率数据，研究了 1989 年至 2003 年间首次因急性心肌梗死住院的西澳大利亚州患者（n=27209）。结果事件是一年内接受冠状动脉手术-血管造影、血管成形术和/或冠状动脉旁路手术（CABG）。我们使用社会经济劣势指数（SEIFA）为每个个体分配社会经济地位（SES）。Cox 回归用于在五个连续的三年时间段中对 SES 与手术率之间的关联进行建模。血管造影和 CABG 显示出扩散的社会经济滞后，SES 较高的患者的手术率更早达到峰值，因此不平等模式与逆向公平假设一致。血管成形术扩散滞后的证据较弱。总的来说，医疗技术扩散存在滞后的证据表明，在检查医疗技术对公平性的影响时，考虑时间趋势至关重要。
