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Ethnic differences in coronary revascularisation following an acute coronary syndrome in New Zealand: A national data-linkage study (ANZACS-QI 12)

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Authors:
Summary:

This research sought to determine ethnic differences in angiography and revascularisation rates among 50,324 30–84-year-olds hospitalised with an acute coronary syndrome (ACS) in New Zealand between 2007 and 2012. Patients’ ethnicities were Māori (10%), Pacific (4%), Indian (3%) and New Zealand European or Other (NZEO, 83%). Compared with all other ethnicities, Māori were admitted more often to hospitals without catheterisation facilities (48% vs 36% of NZEO, 19% of Pacific people and 14% of Indian patients). Māori and Pacific patients had a higher comorbidity burden (22–24%) compared with NZEO and Indian patients (12–13%). Multilevel Cox regression, accounting for individual factors and admitting hospital, was used to estimate adjusted procedural rates within 30 days of admission. Māori and Pacific were less likely than NZEO patients to undergo angiography (adjusted HRs 0.94 [95% CI, 0.91 to 0.98] and 0.93 [95% CI, 0.87 to 0.98], respectively) and revascularisation (adjusted HRs 0.79 [95% CI, 0.75 to 0.83] and 0.77 [95% CI, 0.71 to 0.83]), even after adjusting for important demographic and clinical factors.

Comment:
Getting past the shameless self promotion, these findings are both disappointing AND hopeful. As some of you know, we did a similar review for the years 1996 to 2004, which showed significant disparities between Māori and non-Māori. So I was disappointed to see that unequal treatment, or ethnic disparities in cardiac interventions, persist a decade later. However, ACS investigation and intervention inequities have improved; a lot of it is due to quality improvement activities that hope to achieve equity. Such work must continue.
Reference: Heart Lung Circ. 2016;25(8):820-8
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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