Socioeconomic inequalities in the diffusion of health technology: Uptake of coronary procedures as an example

This paper examines socioeconomic lags in the diffusion of high technology health care, focusing on the diffusion of coronary procedures in people with ischaemic heart disease. Using linked hospital and mortality data, we studied patients admitted to Western Australian hospitals with a first admission for acute myocardial infarction between 1989 and 2003 (n = 27,209). An outcome event was the receipt, within a year, of a coronary procedure—angiography, angioplasty and/or coronary artery bypass surgery (CABG). Socioeconomic status (SES) was assigned to each individual using the SEIFA Index of Disadvantage. Cox regression was used to model the association between SES and procedure rates in five consecutive three-year time periods. Angiography and CABG showed socioeconomic lags in diffusion, with rates peaking earlier in higher SES patients, such that the inequality patterns were consistent with the inverse equity hypothesis. The evidence for a lag in diffusion for angioplasty was weaker. Overall, that there is some evidence for a lag in diffusion of health technology indicates that it is essential to consider trends over time when examining the equity impact of health technologies.

Research highlights
► We examine socioeconomic inequalities in the diffusion of health care technology.
► We quantify uptake of angiography, angioplasty and CABG between 1989 and 2003 by SES.
► SES lags in diffusion are observed for angiography and CABG.
► There is weaker evidence for an SES lag in diffusion of angioplasty.
► Patterns of diffusion are consistent with the inverse equity hypothesis.