Socioeconomic inequalities in access to treatment for coronary heart disease: A systematic review

• Published in: International journal of cardiology Vol. 219; pp. 70 - 78
• Main Authors: Schröder, Sara L, Richter, Matthias, Schröder, Jochen, Frantz, Stefan, Fink, Astrid
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 15.09.2016
• Subjects: Cardiovascular; Coronary Disease - diagnosis; Coronary Disease - economics; Coronary Disease - therapy; Coronary heart disease; Health services accessibility; Health Services Accessibility - economics; Healthcare disparities; Healthcare Disparities - economics; Humans; Social Class; Socioeconomic inequality; Socioeconomic status; Treatment Outcome; coronary heart disease; health services accessibility; healthcare disparities; socioeconomic status; socioeconomic inequality; Socioeconomic status; Healthcare disparities; Socioeconomic inequality; Coronary heart disease; Health services accessibility
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.05.066

Abstract Strong socioeconomic inequalities exist in cardiovascular mortality and morbidity. The current review aims to synthesize the current evidence on the association between socioeconomic status (SES) and access to treatment of coronary heart disease (CHD). We examined quantitative studies analyzing the relationship between SES and access to CHD treatment that were published between 1996 and 2015. Our data sources included Medline and Web of Science. Our search yielded a total of 2066 records, 57 of which met our inclusion criteria. Low SES was found to be associated with low access to coronary procedures and secondary prevention. Access to coronary procedures, especially coronary angiography, was mainly related to SES to the disadvantage of patients with low SES. However, access to drug treatment and cardiac rehabilitation were only associated with SES in about half of the studies. The association between SES and access to treatment for CHD was stronger when SES was measured based on individual-level compared to area level, and stronger for individuals living in countries without universal health coverage. Socioeconomic inequalities exist in access to CHD treatment, and universal health coverage shows only a minor effect on this relationship. Inequalities diminish along the treatment pathway for CHD from diagnostic procedures to secondary prevention. We therefore conclude that CHD might be underdiagnosed in patients with low SES. Our results indicate that there is an urgent need to improve access to CHD treatment, especially by increasing the supply of diagnostic angiographies, to reduce inequalities across different healthcare systems.