Institute of Medical Sociology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Eur J Public Health. 2017 Dec 1;27(6):1055-1060. doi: 10.1093/eurpub/ckx147.
Socioeconomic inequalities in coronary heart disease (CHD)-related morbidity and mortality are well explored. However, less is known about the causes of inequalities in CHD treatment. In this qualitative study, we explored socioeconomic differences in the pathways to diagnosis of CHD.
The data originated from 38 semi-structured interviews with older CHD patients, aged 59-80 years, conducted at the university hospital in Halle, Germany, between November 2014 and April 2015. We analysed the narratives related to the time before CHD was confirmed by coronary angiography electively or urgently. Transcripts were analysed following inductive qualitative content analysis and we identified socioeconomic differences by comparing and contrasting patients' narratives.
The patients interpreted their symptoms based on expectations, normalization, relief and obtaining help from third parties. For those experiencing chronic CHD symptoms, only patients with low socioeconomic status (SES) waited to seek healthcare until they suffered myocardial infarction. Mainly low-SES patients procrastinated in undergoing diagnostic procedures. We found no socioeconomic differences in the urgent pathway. However, along the elective pathway, only low-SES patients reported receiving assistance from a general practitioner in accessing a cardiologist.
Socioeconomic differences in CHD diagnosis were mainly apparent before patients sought healthcare. These differences were more pronounced when CHD was electively diagnosed due to chronic symptoms rather than urgently diagnosed due to acute symptoms. To address socioeconomic differences, general practitioners should focus on any indication of symptoms and interpretation mentioned by low-SES patients, and coordinate these patients' pathways to diagnosis while emphasizing the seriousness of CHD.
社会经济不平等与冠心病（CHD）相关的发病率和死亡率有很好的研究。然而，对于 CHD 治疗不平等的原因知之甚少。在这项定性研究中，我们探讨了 CHD 诊断途径中的社会经济差异。
数据来自 2014 年 11 月至 2015 年 4 月在德国哈勒大学医院进行的 38 名年龄在 59-80 岁之间的老年 CHD 患者的半结构化访谈。我们分析了与选择性或紧急冠状动脉造影确诊 CHD 之前时间相关的叙述。根据归纳定性内容分析分析了转录本，并通过比较和对比患者的叙述来确定社会经济差异。
患者根据期望、正常化、缓解和从第三方获得帮助来解释他们的症状。对于那些经历慢性 CHD 症状的患者，只有社会经济地位较低（SES）的患者等到心肌梗塞后才寻求医疗保健。主要是 SES 较低的患者拖延进行诊断程序。我们在紧急途径中没有发现社会经济差异。然而，沿着选择性途径，只有 SES 较低的患者报告在寻求心脏病专家时得到全科医生的帮助。
CHD 诊断中的社会经济差异主要出现在患者寻求医疗保健之前。当 CHD 由于慢性症状而选择性诊断而不是由于急性症状而紧急诊断时，这些差异更为明显。为了解决社会经济差异，全科医生应关注 SES 较低的患者提到的任何症状和解释的迹象，并协调这些患者的诊断途径，同时强调 CHD 的严重性。
