Nfhk2011 nana folmann hempler_parallel25

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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 Copenhagen

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Nfhk2011 nana folmann hempler_parallel25

  1. 1. 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
  2. 2. Research questionsDo immigrants receive adequate medicaltreatment with beta-blockers and statins afteracute myocardial infarction, compared withnative Danes?Are potential differences partially explainedby social inequalities?
  3. 3. Data on cardiovascular disease (CVD) amongNon-Western immigrants in DenmarkIncreased number of CVD-specific hospital contactsFolmann and Jørgensen 2006, Ingerslev 2000Increased diabetesKristensen et al. 2007CVD risk factors increasedSinghammer 2008Increased incidence of CVD and AMI among Turksand PakistanisHempler NF et al. 2011
  4. 4. Data on CVDLack of studies regarding:• Immigrants’ access to healthcare services• Whether immigrants with CVD receive adequate treatment
  5. 5. BackgroundImmigrants and descendants comprise 10% of the populationStatistics Denmark 2010Two-thirds originate from a non-Western country
  6. 6. Background
  7. 7. MethodsCapital Region of Denmark or Central DenmarkRegion (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
  8. 8. DefinitionsNative Danes were used as the reference groupHowever, not a gold standard
  9. 9. Social inequalities Health Differences in socioeconomic Access to healthcare services status (SES) Quality of care
  10. 10. Socioeconomic status (SES)Lower SES among non-Western immigrants comparedwith native Danes• Income• Education• Employment• Housing conditions
  11. 11. Data Sources The Danish National Patient Registry The Integrated The Danish Registry Database for Labour The Central of Medical Product Market Research Population Statistics RegistryThe Danish The Registry ofDemographic Causes of DeathRegistry Admissions Redeemed prescriptions Employment, income Country of birth Migrations Deaths
  12. 12. Country of BirthImmigrant:Born in a foreign country to parents withoutDanish citizenship also born in a foreign countryDescendant:Born in Denmark to parents born in a foreigncountry without Danish citizenshipNative Dane:Individual with at least one parent, who is aDanish citizen born in Denmark
  13. 13. DesignInclusion criteria:Residence inDenmark 1997-20001997 Baseline 2005 (2001) Initiation Persistence
  14. 14. FactsGuidelines recommend treatment with statins andbeta-blockers after AMIPrescription drugs require co-payment
  15. 15. MethodsNo previous history of AMIDischarged alive after first AMI22,335 individuals (322 immigrants)Covariates: age, sex, employment, incomeOutcomes: Statins and beta-blockersInitiation: within 14 days after dischargePersistence: no refill 90 days after the defined daily dose expired
  16. 16. Results – initiation (OR)Ref.: native Danes
  17. 17. Results – persistence (HR) Ref.: native Danes
  18. 18. ConclusionsPakistanis and Turks were less likely to receiveadequate treatment with beta-blockers after AMIPoorer persistence with statins and, in particular, beta-blockersA trend of better initiation among immigrant groupsNo strong effect of SES was observed
  19. 19. Interpretation of resultsInsufficient indicators of SESCommunication obstacles between provider and patientLack of social supportDifferences in perceived needUse of cross border healthcare services
  20. 20. DiscussionStrengths:Follow-up designMeasurement of SES before measurement of outcomeRegistry-based data of high quality regarding the outcomesCountry of birth categoriesLimitations:Small sample size of immigrants groups (type II errors)Cases before 1997 could not be identifiedMisclassification of outcomeBroad categories (SES indicators)Poor validity of educationCountry of birth does not take ethnic identity, culture andlanguage into account
  21. 21. Further readingHempler NF, Diderichsen F, Larsen FB, Ladelund S,Jorgensen T.Do immigrants from Turkey, Pakistan and Yugoslaviareceive adequate medical treatment with beta-blockers and statins after acute myocardial infarctioncompared with Danish-born residents? A register-based follow-up study.Eur J Clin Pharmacol 2010; 66(7): 735-42.
  22. 22. Thank you for your attention The Copenhagen Center for Healthy Aging is supported by the Danish foundation

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