Socioeconomic inequalities in the diffusion of health technology: Uptake of coronary procedures as an example

• Published in: Social science & medicine (1982) Vol. 72; no. 2; pp. 224 - 229
• Main Authors: Korda, Rosemary J., Clements, Mark S., Dixon, Jane
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 2011; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Angioplasty; Angioplasty - utilization; Australia; Biological and medical sciences; Biomedical Technology; Coronary Angiography - utilization; Coronary Artery Bypass - utilization; Coronary procedures; Diffusion; Diffusion of Innovation; Equality; Equity; Female; Health care; Health Care Services; Healthcare Disparities - trends; Heart attacks; Heart disease; Heart Diseases; Hospitals; Humans; Inequalities; Inequalities Socioeconomic status Diffusion Technology Health care Coronary procedures Australia Heart disease Time trends; Inequality; Male; Medical sciences; Medical Technology; Medicine; Miscellaneous; Mortality; Myocardial Infarction - therapy; Patient admissions; Patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; Social Class; Socioeconomic factors; Socioeconomic Status; Studies; Surgery; Technology; Time trends; Western Australia; Australia; Oceania; Western Australia; Western Australia Australia; Health care; Socioeconomic status; Technology; Coronary procedures; Heart disease; Inequalities; Time trends; Diffusion; Australia; Human; Coronary artery; Trend; Cardiovascular disease; Socioeconomics; Time variation; Uptake; Care; Procedure; Social medicine; Economic aspect; Social aspect; Public health; Inequality
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2010.11.002

This paper examines socioeconomic lags in the diffusion of high technology health care, focusing on the diffusion of coronary procedures in people with ischaemic heart disease. Using linked hospital and mortality data, we studied patients admitted to Western Australian hospitals with a first admission for acute myocardial infarction between 1989 and 2003 (
n = 27,209). An outcome event was the receipt, within a year, of a coronary procedure—angiography, angioplasty and/or coronary artery bypass surgery (CABG). Socioeconomic status (SES) was assigned to each individual using the SEIFA Index of Disadvantage. Cox regression was used to model the association between SES and procedure rates in five consecutive three-year time periods. Angiography and CABG showed socioeconomic lags in diffusion, with rates peaking earlier in higher SES patients, such that the inequality patterns were consistent with the inverse equity hypothesis. The evidence for a lag in diffusion for angioplasty was weaker. Overall, that there is some evidence for a lag in diffusion of health technology indicates that it is essential to consider trends over time when examining the equity impact of health technologies.
► We examine socioeconomic inequalities in the diffusion of health care technology. ► We quantify uptake of angiography, angioplasty and CABG between 1989 and 2003 by SES. ► SES lags in diffusion are observed for angiography and CABG. ► There is weaker evidence for an SES lag in diffusion of angioplasty. ► Patterns of diffusion are consistent with the inverse equity hypothesis.