Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.
BMC Public Health. 2022 Feb 14;22(1):303. doi: 10.1186/s12889-022-12628-9.
The aim of this study was to analyse whether there are patient related or geographic differences in the use of catheter ablation among atrial fibrillation patients in Norway.
National population-based data on individual level of all Norwegians aged 25 to 75 diagnosed with atrial fibrillation from 2008 to 2017 were used to study the proportion treated with catheter ablation. Survival analysis, by Cox regression with attained age as time scale, separately by gender, was applied to examine the associations between ablation probability and educational level, income level, place of residence, and follow-up time.
Substantial socioeconomic and geographic variation was documented. Atrial fibrillation patients with high level of education and high income were more frequently treated with ablation, and the education effect increased with increasing age. Patients living in the referral area of St. Olavs Hospital Trust had around three times as high ablation rates as patients living in the referral area of Finnmark Hospital Trust.
Differences in health literacy, patient preference and demands are probably important causes of socioeconomic variation, and studies on how socioeconomic status influences the choice of treatment are warranted. Some of the geographic variation may reflect differences in ablation capacity. However, geographic variation related to differences in clinical practice and provider preferences implies a need for clearer guidelines, both at the specialist level and at the referring level.
本研究旨在分析在挪威，房颤患者中导管消融的使用是否存在与患者相关或与地理位置相关的差异。
本研究使用了全国范围内的人群基础数据，对 2008 年至 2017 年间所有年龄在 25 至 75 岁之间被诊断为房颤的挪威人进行了个体水平的研究，以研究接受导管消融治疗的比例。通过 Cox 回归分析，以达到的年龄作为时间尺度，分别按性别进行生存分析，以检查消融概率与教育水平、收入水平、居住地和随访时间之间的关系。
研究结果显示存在大量的社会经济和地理位置差异。具有较高教育水平和高收入的房颤患者更频繁地接受消融治疗，且教育效果随着年龄的增长而增加。居住在圣奥拉夫医院信托区的患者的消融率约为居住在芬马克医院信托区的患者的三倍。
健康素养、患者偏好和需求方面的差异可能是社会经济差异的重要原因，有必要研究社会经济状况如何影响治疗选择。一些地理位置差异可能反映了消融能力的差异。然而，与临床实践和提供者偏好相关的地理差异表明需要更明确的指南，无论是在专家层面还是在转诊层面。
