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APHA Scientific Session and Event Listing

Recorded presentation

John R. Beard, MBBS PhD, FAFPHM¹, Geoff Morgan, PhD², Arul Earnest, MSc², Richard Summerhayes, MPH³, Danielle C. Ompad, PhD⁴, and Angela M. Bucciarelli, MPH⁴. (1) Centre for Urban Epidemiologic Studies, New York Acadamy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212-822-7378, jbeard@nyam.org, (2) Northern Rivers University Department of Rural Health, University of Sydney; Southern Cross University, PO Box 3074, Lismore, Australia, (3) Northern Rivers University Department of Rural Health, Southern Cross University, PO Box 3074, Lismore, Australia, (4) Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029

We used spatio-temporal models to examine the relationship between socio-economic status and hospital admissions for acute myocardial infarction (AMI) and related procedures in the state of New South Wales, Australia for the period 1996 to 2002. We also quantified the effect of other variables including remoteness, Sydney postal areas and Indigenous status. We calculated indirect sex and age standardised counts of the outcomes at the postal-area level using data from the New South Wales (NSW) Inpatient Statistics Collection. Data on Index of Relative Social Disadvantage (IRSD), Accessibility and Remoteness Index for Australia (ARIA-plus), and proportion of Aboriginal & Torres Strait Islander (ATSI) were obtained from the Australian Bureau of statistics.

There was a strong exposure-response relationship between increasing disadvantage and AMI admissions. Accessibility and remoteness also explained some of the spatial variation in the admissions data, after adjusting for socio-economic status, although Indigenous status did not. AMI related procedures, such as cardiac catheterisations, Coronary Artery Bypass Grafts and stents were also spatially distributed, however these demonstrated an inverse relationship with disadvantage and, in some regions, this increased over the study period.

Socioeconomic disadvantage appears to increase risk for AMI, but reduce an individual's chance of receiving appropriate medical intervention. This disparity does not appear to be waning. We will discuss the temporal patterns associated with these changes, and their implications for health policy makers.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Recognize factors influencing the spatial distribution of diseases like ischemic heart disease
• Understand the principles of some spatial analytical techniques.
• Have a better undertanding of the influence socioeconomic status has on the incidence and management of ischemic heart disease

Keywords: Social Inequalities, Heart Disease

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation