Revascularization procedures after acute myocardial infarction: are there disparities between ethnic minority groups and the Dutch majority population?
Ethnic differences in receiving revascularization procedures after coronary heart disease are rarely studied in European countries with an egalitarian health care system. We investigated disparities in revascularization rate after an acute myocardial infarction (AMI) between ethnic minority groups (Hindustani Surinamese, non-Hindustani Surinamese, Moroccans, and Turkish) and the Dutch majority population.
METHODS:
All AMI events between 2006 and 2011 were identified in a subset of the Agis Health Database (n=3,402). Multivariable Cox proportional hazards regression analyses were used to identify ethnic differences in revascularization rate (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)) in AMI patients and in ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (non-STEMI) patients separately.
RESULTS:
On average, 58.2% of AMI events were followed by a revascularization procedure. After adjustment for age, sex, degree of urbanization, and socioeconomic status, no significant differences in revascularization rate were found between the Dutch majority population and Hindustani Surinamese, non-Hindustani Surinamese, Moroccan and Turkish minorities. After additional adjustment for comorbidity and AMI type, Moroccan minorities had a borderline significantly lower revascularization rate compared with the Dutch majority population (0.84; 0.71-0.99).
CONCLUSIONS:
In the Netherlands, a country with an egalitarian health care system, no ethnic inequalities in revascularization rate after an acute myocardial infarction were observed, except for a slightly lower revascularization rate among Moroccan AMI patients. Future research should elucidate the underlying factors of this lower rate, for example the influence of disease severity.