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Is There an Age Pattern in the Treatment of AMI? Evidence from Ontario*

Published online by Cambridge University Press:  24 August 2010

Michel Grignon ,
Byron G. Spencer  and
Li Wang
Michel Grignon*
Affiliation:
McMaster University
Byron G. Spencer
Affiliation:
McMaster University
Li Wang
Affiliation:
McMaster University
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Michel Grignon, Ph.D., McMaster University, Department of Economics, KTH-426, Hamilton, Ontario, L8S 4M4 ([email protected])
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Abstract

In this article we analyse the rates at which those admitted to hospital with acute myocardial infarction (AMI) receive aggressive treatment, assess how those rates have changed over time, and ask whether there is evidence of age discrepancies. Estimates made on the basis of data from an administrative database that includes discharges from all acute care hospitals in Ontario for selected years, from 1995 to 2005, indicate that there are strong and persistent age patterns in the application of medical technology. Results showed that to be true even after controlling for the higher rates of co-morbidities among older patients and variations across hospitals in practice patterns.

Résumé

Dans cet article nous analysons la probabilité pour un patient hospitalisé pour infarctus du myocarde de recevoir des traitements chirurgicaux, puis nous mesurons les changements dans le temps de cette probabilité et cherchons à savoir si l’âge du patient joue sur la probabilité. Nos estimations, fondées sur des données administratives incluant tous les séjours dans les hôpitaux de soins aigus de l’Ontario pour certaines années entre 1995 et 2005, font état d’un profil par âge marqué et stable dans le temps dans la diffusion de la technologie médicale. Nos résultats montrent que ceci est robuste à l’inclusion de contrôles pour la plus forte fréquence de co-morbidités chez les patients âgés ainsi que pour les effets de pratiques propres aux hôpitaux.

Keywords

traitement de l’infarctus du myocardeprofil par âgetreatment of AMIage pattern
Type
Special SEDAP Section: Canada’s Vulnerable Older Populations / Section spéciale SEDAP: Les Populations âgées vulnérables du Canada: Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 29 , Issue 3 , September 2010 , pp. 317 - 332
Copyright
Copyright © Canadian Association on Gerontology 2010

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Footnotes

*

This article presents some results of research carried out under “The McMaster Pilot”, an agreement worked out between the Ontario Ministry of Health and Long-Term Care, Statistics Canada, and the Statistics Canada Research Data Centre at McMaster University. We are grateful to the Ministry for making selected administrative data files available for this pilot and for its financial support and also to CHEPA (The Centre for Health Economics and Policy Analysis) and SEDAP (Social and Economic Dimensions of an Aging Population) for their support. The authors alone are responsible for the views expressed here.

References

Austin, P.C., Tu, J.V., Ko, D.T., & Alter, D.A. (2008). Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction. Canadian Medical Association Journal, 179(9), 901–908.CrossRefGoogle ScholarPubMed
Beck, C.A., Penrod, J., Gyorkos, T.W., Shapiro, S., & Pilote, L. (2003). Does aggressive care following acute myocardial infarction reduce mortality? Analysis with instrumental variables to compare effectiveness in Canadian and United States patient populations. Health Services Research, 38(6, Pt I), 1423–1442.Google Scholar
Busschbach, J.J., Hessing, D.J., & De Charro, F.T. (1993). The utility of health at different stages in life: A quantitative approach. Social Science and Medicine, 37(2), 153–158.CrossRefGoogle ScholarPubMed
Chen, J., Rathore, S.S., Radford, M.J., Wang, Y., & Krumholz, H.M. (2001). Racial differences in the use of cardiac catheterization after acute myocardial infarction. New England Journal of Medicine, 344(19), 1443–1449.CrossRefGoogle ScholarPubMed
Enhanced Feedback For Effective Cardiac Treatment. (2005). Quality of cardiac care in Ontario. Report 2, Phase 1, Report 2, Group B. Toronto, ON, Canada: Canadian Cardiovascular Outcomes Research Team and Institute for Clinical Evaluation Sciences.Google Scholar
Gusmano, M.K., Rodwin, V.G., Weisz, D., & Das, D. (2007). A new approach to the comparative analysis of health systems: Invasive treatment for heart disease in the US, France, and their two world cities. Health Economics, Policy and Law, 2, 73–92.CrossRefGoogle Scholar
Ko, D.T., Krumholz, H.M., Wang, Y., Foody, J.A.M., Masoudi, F.A., Havranek, E.P., et al. . (2007). Regional differences in process of care and outcomes for older acute myocardial infarction patients in the United States and Ontario, Canada. Circulation, Journal of the American Heart Association, 115, 196–203.Google Scholar
McClennan, M., McNeil, B.J., & Newhouse, J.P. (1994). Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Journal of the American Medical Association, 272(11), 859–66.CrossRefGoogle Scholar
Moise, P., Jacobzone, S.; the ARD-IHD Experts Group. (2003). OECD study of cross-national differences in the treatment, costs and outcomes of ischaemic heart disease. OECD DELSA Health Working Paper #3, Paris, France: OECD-OCDE.Google Scholar
Naglie, G., Tansey, C., Krahn, M.D., O’Rourke, K., Detsky, A.S., & Bolley, H. (1999). Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65. Canadian Medical Association Journal, 160(6), 860–865.Google ScholarPubMed
Organization for Economic Cooperation and Economic Development. (2009). Health database. Paris, France: OECD-OCDE.Google Scholar
Pilote, L., Granger, C., Armstrong, P.W., Mark, D.B., & Hlatky, M.A. (1995). Differences in the treatment of myocardial infarction between the United States and Canada—A survey of physicians in the GUSTO trial. Medical Care, 33(6), 598–610.CrossRefGoogle ScholarPubMed
Pilote, L., Joseph, L., Bélisle, P., & Penrod, J. (2003). Universal health insurance coverage does not eliminate inequities in access to cardiac procedures after acute myocardial infarction. American Heart Journal, 146(6), 1030–1037.Google Scholar
Pilote, L., Lavoie, F., Ho, S., & Eisenberg, M.J. (2000). Changes in the treatment and outcomes of acute myocardial infarction in Quebec, 1988–1995. Canadian Medical Association Journal, 163(1), 31–36.Google Scholar
Rathore, S.S., Wang, Y., Radford, M.J., Ordin, D.L., & Krumholz, H.M. (2002). Sex difference in cardiac catheterization after acute myocardial infarction: The role of procedure appropriateness. Annals of Internal Medicine, 137(6), 487–493.CrossRefGoogle ScholarPubMed
Spencer, G., Wang, J., Donovan, G., & Tu, J.V. (2008). Report on coronary artery bypass surgery in Ontario, fiscal years 2005/06 and 2006/07. Toronto, ON, Canada: Institute for Clinical Evaluation Sciences (Toronto) in collaboration with the Cardiac Care Network of Ontario.Google Scholar
Strech, D., Synofsik, M., & Marckmann, G. (2008). How physicians allocate scarce resources at the bedside: A systematic review of qualitative studies. Journal of Medicine and Philosophy, 33, 80–99.Google Scholar
Tu, J.V., Austin, P.C., Filate, W.A., Johansen, H.L., Brien, S.E., Pilote, L., et al. . (2003). Outcomes of AMI in Canada. Canadian Journal of Cardiology, 19(8), 893–901.Google Scholar
Williams, A. (1997) Rationing health care by age—The case for. BMJ, 314, 820–822.Google Scholar