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Examining Equity in Access to Health Care Using Register Data

Pathways to Coronary Revascularisations in Finland 1995-1998

Kajantie, Mira

Suomenkielinen tiivistelmä English abstract

Suomenkielinen tiivistelmä

Administrative registers provide an inexhaustible source of information being beneficially exploited as a growing trend by social researchers. Register-based research differs in some ways from the traditional ways of carrying out research. The purpose of this study was to examine the possibilities that register data provide for equity in health care research, and to illustrate how the project can be conducted in practice.

The process of register-based research was examined through actual research data. Study data was a part of the STAKES research data originally collected to identify the coronary heart disease population and to examine differences in the treatment of the disease in Finland in 1995-1998. Originally compiled for other purposes, register data were reworked into a retrospective cohort study setting. The purpose was to examine possible socioeconomic differences in treatment histories among patients that underwent their first revascularisation operation (coronary angioplasty or coronary artery bypass grafting) during the years 1995-1998. Statistical methods used in this study are commonly used in epidemiological research, including logistic and multinomial logistic regression, Poisson regression and Cox regression.

Based on previous research, it was known that higher socioeconomic groups received more revascularisations than those worse-off during the 1990s. This study aimed to conclude whether patients in higher socioeconomic groups received the operation during an earlier stage of the disease as based on their treatment history. According to the results, statistically significant differences that favouring those better-off existed in 1995-1998 in the pathways to revascularisation. Patients from higher socioeconomic groups received surgery sooner after the diagnosis and had fewer acute hospitalisations due to coronary heart disease in their treatment histories. The study used several graphic and statistical methods to gain a more detailed picture of the pathways to revascularisation.