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Title: Socioeconomic gradients in admission to coronary or intensive care units among Australians presenting with non-traumatic chest pain in emergency departments.
Austin Authors: Mnatzaganian, George;Hiller, Janet E;Fletcher, Jason;Putland, Mark;Knott, Cameron I ;Braitberg, George;Begg, Steve;Bish, Melanie
Affiliation: Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
Intensive Care Unit, Bendigo Health, Barnard Street, Bendigo, Victoria, Australia
La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia
School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, John Street, Hawthorn, Victoria, Australia
School of Public Health, The University of Adelaide, North Terrace, Adelaide, SA, Australia
Monash Rural Health Bendigo, Monash University, Bendigo, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Centre for Integrated Critical Care Medicine, Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, Australia
Issue Date: 29-Sep-2018 2018-09-29
Publication information: BMC emergency medicine 2018; 18(1): 32
Abstract: Socioeconomic inequalities in cardiovascular morbidity have been previously reported showing direct associations between socioeconomic disadvantage and worse health outcomes. However, disagreement remains regarding the strength of the direct associations. The main objective of this panel design was to inspect socioeconomic gradients in admission to a coronary care unit (CCU) or an intensive care unit (ICU) among adult patients presenting with non-traumatic chest pain in three acute-care public hospitals in Victoria, Australia, during 2009-2013. Consecutive adults aged 18 or over presenting with chest pain in three emergency departments (ED) in Victoria, Australia during the five-year study period were eligible to participate. A relative index of inequality of socioeconomic status (SES) was estimated based on residential postcode socioeconomic index for areas (SEIFA) disadvantage scores. Admission to specialised care units over repeated presentations was modelled using a multivariable Generalized Estimating Equations approach that accounted for various socio-demographic and clinical variables. Non-traumatic chest pain accounted for 10% of all presentations in the emergency departments (ED). A total of 53,177 individuals presented during the study period, with 22.5% presenting more than once. Of all patients, 17,579 (33.1%) were hospitalised over time, of whom 8584 (48.8%) were treated in a specialised care unit. Female sex was independently associated with fewer admissions to CCU / ICU, whereas, a dose-response effect of socioeconomic disadvantage and admission to CCU / ICU was found, with risk of admission increasing incrementally as SES declined. Patients coming from the lowest SES locations were 27% more likely to be admitted to these units compared with those coming from the least disadvantaged locations, p <  0.001. Men were significantly more likely to be admitted to such units than similarly affected and aged women among those diagnosed with angina pectoris, arrhythmia, myocardial infarction, heart failure, chest pain, and general signs and symptoms. This study is the first to report socioeconomic gradients in admission to CCU / ICU in patients presenting with chest pain showing a dose-response effect. Our findings suggest increased cardiovascular morbidity as socioeconomic disadvantage increases.
DOI: 10.1186/s12873-018-0185-2
ORCID: 0000-0002-7698-5091
PubMed URL: 30268098
Type: Journal Article
Subjects: Cardiovascular morbidity
Chest pain
Emergency department
Intensive care
Socioeconomic gradients
Appears in Collections:Journal articles

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