Socioeconomic and gender inequities in access to coronary artery bypass grafting in Finland

Abstract

This study describes socioeconomic and gender differences in the use of coronary artery bypass grafting in relation to the need and regional supply of these operations in Finland. We established the rates of bypass operations performed for patients aged 40–69 years by social class, education and disposable income and compared the operation rates to mortality from and risk of hospitalization due to coronary heart disease in the same socioeconomic groups. The data on bypass operations and hospital use were derived from a data set linking individually the 1988 Finnish Hospital Discharge Register and the 1987 population census. The data on coronary heart disease mortality came from a similar linkage scheme of the 1986–1991 cause of death registers and the 1985 census. Among men, coronary bypass was more common for those in high socioeconomic categories for the variables analysed and in all age groups. These disparities in operation rates were inverse to the socioeconomic gradients in mortality from and risk of hospitalization due to coronary heart disease. Among women, the socioeconomic trends in surgery rates were not similar for all socioeconomic variables, but in relation to need showed higher use among the better-off. In relation to hospitalization due to coronary heart disease, women received proportionally less surgery than men. In hospital districts with the lowest overall bypass surgery rates, the distribution of operations more clearly favoured men and high socioeconomic groups than elsewhere. In the late 1980s clear discrepancies existed between the need for and use of coronary artery bypass surgery across socioeconomic groups in Finland. Some evidence also suggested corresponding inequities between genders.