PCI outcomes worse for Indigenous Australians at urban, regional centers
For Indigenous Australians, PCI procedures performed at larger urban and regional centers were associated with increased risk for mortality and adverse cardiac events, independent of socioeconomic status and geographical remoteness.
“Improving Indigenous health status has been a long-standing goal in Australia, and the gap in health outcomes remains intolerably wide,” Luke P. Dawson, MPH, of the department of cardiology at Royal Melbourne Hospital, Australia, and colleagues wrote in the study published in The Lancet Global Health.
The multicenter, prospective, observational cohort study included data collected from six government-funded tertiary hospitals in Victoria, Australia, a state that accounts for roughly 6.4 million people and 7.2% of Australia’s Indigenous population, according to the study background. Dawson and colleagues used the Melbourne Interventional Group PCI registry to identify patients who received PCI at Victorian metropolitan and large regional hospitals from January 2005 to December 2018.
The primary outcome was long-term mortality, with 30-day mortality and 30-day major adverse CV events serving as secondary outcomes.
Overall, 41,146 patient procedures were entered into the registry, of which 0.4% were identified as Indigenous Australian and 96.9% were not; the remaining 2.7% were excluded for having incomplete data on ethnicity.
Compared with non-Indigenous patients, those identified as Indigenous were younger and more often women, and were more likely to have comorbidities and reside in inner regional, outer regional or remote communities and areas of socioeconomic disadvantage. Procedural success and complication rates for patients having PCI were similar between groups.
At 30 days, Indigenous Australians demonstrated an increased likelihood of taking optimal medical therapy; however, they also had lower follow-up rates and were more likely to be persistent smokers.
In multivariable analysis, Indigenous status independently yielded an increased risk for long-term mortality (HR = 2.49; 95% CI, 1.79-3.48; P < .0001), 30-day mortality (OR = 2.78; 95% CI, 1.09-7.12; P = .033) and 30-day MACE (OR = 1.87; 95% CI, 1.03-3.39; P = .039) compared with non-Indigenous status.
“The reasons for these disparities are complex, including social determinants of health, communication difficulties, poor access to care and cultural safety,” Dawson and colleagues wrote. “Improvements in PCI outcomes in Indigenous Australians should be a focus for health policy, and programs targeting timely access to PCI for regional patients and close clinical follow-up, including telemedicine and access to specialists, could be of great value.”
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