Reducing Health Inequalities: Comparison of Survival After Acute Myocardial Infarction According to Health Provider in Chile.
| Autor: | Alonso, Faustino, Nazzal, Carolina, Cerecera, Francisco, Ojeda, José Ignacio |
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| Předmět: |
CHI-squared test
CONFIDENCE intervals HEALTH care reform HEALTH services accessibility HEALTH status indicators PROPRIETARY hospitals LONGITUDINAL method MYOCARDIAL infarction NOSOLOGY PUBLIC hospitals REGRESSION analysis RESEARCH funding SURVIVAL analysis (Biometry) PROPORTIONAL hazards models DATA analysis software DESCRIPTIVE statistics KAPLAN-Meier estimator MANN Whitney U Test |
| Zdroj: | International Journal of Health Services; Jan2019, Vol. 49 Issue 1, p127-141, 15p, 4 Charts, 2 Graphs |
| Abstrakt: | Health inequalities are marked in Chile. To address this situation, a health reform was implemented in 2005 that guarantees acute myocardial infarction (AMI) health care for the entire population. We evaluated if the health reform changed AMI early and long-term survival rates by hospital provider (public/private) using a longitudinal population-based study of patients ≥15 years with a first AMI in Chile between 2002 and 2011. Time trends and early (within 28 days) and long-term (29–365 days) survival by age were assessed. We identified 59,557 patients: median age of 64 years; 68.9% men; 83.2% treated at public hospitals; 74.4% with public insurance. Early and long-term case-fatality was higher at public hospitals (14.6% vs 9.3%; P < .001 and 5.8% vs 3.3%; P < .001, respectively). There was a higher annual increase for early and long-term survival in public hospitals, 0.008 percentage points (95% CI: 0.006, 0.009; P < .0001) and 0.03 (0.002, 0.003; P < .0001), than in private hospitals, 0.0002 (95% CI: −0.0001, 0.005; P = .10) and 0.002 (95% CI: 0.0007, 0.003; P = .004), respectively. Being served at public hospitals affected early and long-term survival, especially in patients <70 years: hazard ratio was 2.01 (95% CI: 1.77, 2.28) and 3.11 (2.41, 4.01), respectively. Therefore, even if inequalities persist, there was a higher increase in early and long-term survival in public versus private hospitals. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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