Education level and the use of coronary computed tomography, functional testing, coronary angiography, revascularization, and outcomes—a 10-year Danish, nationwide, registry-based follow-up study

医学 血运重建 丹麦语 冠状动脉疾病 内科学 心脏病学 队列 急诊医学 心肌梗塞 语言学 哲学
作者
Marc Meller Søndergaard,Phillip Freeman,Allan Kristensen,Su Min Chang,Khurram Nassir,Martin Bødtker Mortensen,Bjarne Linde Nørgaard,Michael Mæng,Mikkel Porsborg Andersen,Peter Søgaard,Bhupendar Tayal,Manan Pareek,Søren Paaske Johnsen,Lars Køber,Gunnar Gislason,Christian Torp‐Pedersen,Kristian Kragholm
出处
期刊:European Heart Journal - Quality of Care and Clinical Outcomes [Oxford University Press]
标识
DOI:10.1093/ehjqcco/qcad052
摘要

Abstract Background and aims Coronary computed tomography angiography (CCTA) can guide downstream preventive treatment and improve patient prognosis, but its use in relation to education level remains unexplored. Methods This nationwide register-based cohort study assessed all residents in Denmark between 2008–2018 without coronary artery disease (CAD) and 50–80 years of age (n = 1 469 724). Residents were divided according to four levels of education: low, lower-mid, higher-mid, and high. Outcomes were CCTA, functional testing, invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE). Results Individuals with the lowest education level underwent CCTA (absolute risk [AR] 3.95% individuals aged ≥ 50–59, AR 3.62% individuals aged ≥ 60–69, AR 2.19% individuals aged ≥ 70–80) less often than individuals of lower-mid (AR 4.16%, AR 3.90%, AR 2.41%), higher-mid (AR 4.38%, AR 4.30%, AR 2.45%) and highest education level (AR 3.98%, AR 4.37%, AR 2.30%). Similar differences were observed for functional testing. Conversely, use of ICA, and risks of revascularization and MACCE were more common among individuals of lowest education level. Among patients examined with CCTA (n = 50 234), patients of lowest education level less often underwent functional testing and more likely initiated preventive medication, underwent ICA, revascularization, and experienced MACCE. Conclusion Despite tax-financed healthcare in Denmark, individuals of lowest education level were less likely to undergo CCTA and functional testing than persons of higher education level. ICA utilization, revascularization and MACCE risks were higher for individuals of lowest education level. Among CCTA-examined patients, patients of lowest education level were more likely to initiate preventive medication and had the highest risks of revascularization and MACCE when compared to higher education level groups. These findings suggest that the preventive potential of CCTA is underutilized in individuals of lower education level, a proxy for socioeconomic status. Socioeconomic differences in CAD assessment, care, and outcomes are likely even larger without tax-financed healthcare.
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