Anderson G M, Grumbach K, Luft H S, Roos L L, Mustard C, Brook R
Institute for Clinical Evaluative Sciences, Ontario, Canada.
JAMA. 1993 Apr 7;269(13):1661-6.
To compare overall rates of coronary artery bypass surgery (CABS) in several Canadian and US jurisdictions and to compare use by age and income groups in the two countries.
Survey, using computerized hospital discharge abstracts.
All nonfederal hospitals in New York, California, Ontario, Manitoba, and British Columbia between 1983 and 1989.
All adult residents of the five jurisdictions who underwent CABS in a hospital in their jurisdiction.
Between 1983 and 1989, the CABS rates were consistently highest in California and lowest in the Canadian jurisdictions. In 1989, the age-adjusted rate of CABS in California (112.5/100,000 adults) was 27% higher than in New York (88.4/100,000) and 80% higher than in the three Canadian provinces combined (62.4/100,000). The CABS rates increased for those aged 65 years and older and decreased for those aged 20 to 54 years in all five jurisdictions. In 1989, CABS rates were three times higher in California than in Canada for those aged 75 years and older, and the higher rates for those aged 65 years and older accounted for 75% of the overall difference in rates between California and Canada. In Canada, CABS rates for the nonelderly varied little by income of area of residence, but in New York and California, rates increased steadily with the income of area of residence.
Control over the supply of resources in Canada is associated with markedly lower CABS rates for the elderly than found in the United States. While overall rates are lower in Canada, the Canadian universal health insurance system reduces the influence of income on access to CABS found in the United States. However, even without universal health insurance, CABS rates for the nonelderly living in the poorest areas in California are similar to the rates for those living in the poorest parts of Canada.
比较加拿大和美国几个司法管辖区冠状动脉搭桥手术（CABS）的总体发生率，并比较两国不同年龄和收入群体的使用情况。
使用计算机化医院出院摘要进行调查。
1983年至1989年期间纽约、加利福尼亚、安大略、马尼托巴和不列颠哥伦比亚的所有非联邦医院。
五个司法管辖区内所有在其辖区医院接受CABS的成年居民。
1983年至1989年期间，CABS发生率在加利福尼亚一直最高，在加拿大司法管辖区最低。1989年，加利福尼亚经年龄调整的CABS发生率（每10万成年人中有112.5例）比纽约（每10万成年人中有88.4例）高27%，比加拿大三个省份的总和（每10万成年人中有62.4例）高80%。在所有五个司法管辖区，65岁及以上人群的CABS发生率上升，20至54岁人群的发生率下降。1989年，75岁及以上人群中，加利福尼亚的CABS发生率是加拿大 的三倍，65岁及以上人群较高的发生率占加利福尼亚和加拿大总体发生率差异的75%。在加拿大，非老年人的CABS发生率因居住地区收入不同变化不大，但在纽约和加利福尼亚，发生率随居住地区收入稳步上升。
加拿大对资源供应的控制与老年人CABS发生率明显低于美国有关。虽然加拿大的总体发生率较低，但加拿大的全民医疗保险系统减少了收入对获得CABS的影响，而美国存在这种影响。然而，即使没有全民医疗保险，居住在加利福尼亚最贫困地区的非老年人的CABS发生率与居住在加拿大最贫困地区的人群相似。
