nfhk2011 nana folmann hempler_parallel25
DESCRIPTION
Quality of care after first acute myocardial infarction (AMI) a comparison of native Danes and immigrants from Turkey, Pakistan and the former Yugoslavia. Nana Folmann Hempler, University of CopenhagenTRANSCRIPT
Quality of care after first acute myocardial
infarction (AMI)
a comparison of native Danes and immigrants from Turkey, Pakistan and the former Yugoslavia
Nana Folmann Hempler, PhD, Post.doc
University of Copenhagen Centre for Healthy Aging
Section for Health Services Research Department of Public Health
Do immigrants receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction, compared with native Danes? Are potential differences partially explained by social inequalities?
Research questions
Increased number of CVD-specific hospital contacts Folmann and Jørgensen 2006, Ingerslev 2000
Increased diabetes Kristensen et al. 2007
CVD risk factors increased Singhammer 2008
Increased incidence of CVD and AMI among Turks and Pakistanis Hempler NF et al. 2011
Data on cardiovascular disease (CVD) among Non-Western immigrants in Denmark
Lack of studies regarding:
• Immigrants’ access to healthcare services
• Whether immigrants with CVD receive adequate treatment
Data on CVD
Immigrants and descendants comprise 10% of the population Statistics Denmark 2010
Two-thirds originate from a non-Western country
Background
Background
Capital Region of Denmark or Central Denmark Region (n=3,107,901)
Study population:
• Native Danes
• Turks, Pakistanis, former Yugoslavians (not including refugees from the civil war)
Non-Western groups with:
• The longest duration of stay in Denmark
• The highest average age
Methods
Native Danes were used as the reference group
However, not a gold standard
Definitions
Social inequalities
Differences in socioeconomic status (SES)
Health Access to healthcare services Quality of care
Socioeconomic status (SES)
Lower SES among non-Western immigrants compared with native Danes
• Income
• Education
• Employment
• Housing conditions
Data Sources
Admissions Redeemed prescriptions
Employment, income Country of birth
Migrations Deaths
The Danish Demographic Registry
The Integrated Database for Labour Market Research
The Danish Registry of Medical Product Statistics
The Registry of Causes of Death
The Danish National Patient Registry
The Central Population Registry
Immigrant:
Born in a foreign country to parents without Danish citizenship also born in a foreign country
Descendant:
Born in Denmark to parents born in a foreign country without Danish citizenship
Native Dane:
Individual with at least one parent, who is a Danish citizen born in Denmark
Country of Birth
Design
1997 2005 Baseline (2001)
Inclusion criteria: Residence in Denmark 1997-2000
Initiation Persistence
Guidelines recommend treatment with statins and beta-blockers after AMI Prescription drugs require co-payment
Facts
No previous history of AMI
Discharged alive after first AMI
22,335 individuals (322 immigrants)
Covariates: age, sex, employment, income
Outcomes: Statins and beta-blockers Initiation: within 14 days after discharge
Persistence: no refill 90 days after the defined daily dose expired
Methods
Results – initiation (OR)
Ref.: native Danes
Results – persistence (HR)
Ref.: native Danes
Conclusions
Pakistanis and Turks were less likely to receive adequate treatment with beta-blockers after AMI
Poorer persistence with statins and, in particular, beta-blockers
A trend of better initiation among immigrant groups
No strong effect of SES was observed
Insufficient indicators of SES
Communication obstacles between provider and patient
Lack of social support
Differences in perceived need
Use of cross border healthcare services
Interpretation of results
Discussion
Strengths:
Follow-up design
Measurement of SES before measurement of outcome
Registry-based data of high quality regarding the outcomes
Country of birth categories
Limitations:
Small sample size of immigrants groups (type II errors)
Cases before 1997 could not be identified
Misclassification of outcome
Broad categories (SES indicators)
Poor validity of education
Country of birth does not take ethnic identity, culture and
language into account
Hempler NF, Diderichsen F, Larsen FB, Ladelund S, Jorgensen T.
Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study.
Eur J Clin Pharmacol 2010; 66(7): 735-42.
Further reading
Thank you for your attention
The Copenhagen Center for Healthy Aging
is supported by the Danish foundation