Published: 26-04-2013 00:00 | Updated: 30-10-2014 10:27

Poorly educated less likely to get intensive heart care

Well-educated individuals have better access to intensive care in the event of a heart attack than the poorly educated, according to a new study by researchers at Karolinska Institutet in collaboration with the Stockholm county healthcare provision and the Swedeheart register. The study also shows that country of birth has no influence on access to intensive care, and that non-Swedish-born patients receive intensive coronary care as frequent as those born in Sweden.

A myocardial infarction, or heart attack, is caused when a blood clot blocks one of the blood vessels that supply the heart muscles with blood and oxygen. It is important then to make the correct diagnosis and begin treatment as soon as possible in order to minimise the damage this causes. It has long been known that intensive care leads to a better prognosis compared to the treatment given by regular treatment, and previous studies have shown that post-coronary mortality differs between the patient groups.

In the present study, which is published in the scientific journal PLOS ONE, the researchers looked at whether these differences depend on inequalities in the care of coronary patients in Sweden. Using the Migration and Health database, which is based on a dozen national registers, the researchers compared almost 200,000 inpatients in Swedish hospitals who had been admitted after having suffered their first heart attack between the years 2001 and 2009. Their aim was to examine how factors such as country of birth, sex and level of education related to the care the patients received.

"Many more patients with a high educational background were treated in intensive care than those with a low educational background", says study leader Tahereh Moradi, docent at Karolinska Institutet's Department of Environmental Medicine. "The difference was roughly 10 per cent and was seen in both sexes, regardless of country of birth. We also found that women had a 20 per cent lower chance of receiving intensive care than men."

The researchers believe that factors such as how the patients communicate with staff, how aware they are of their health, and how demanding they are as regards the care they receive can explain why the more highly educated receive better care. As for the sex difference, one possible reason is that the symptoms of myocardial infarction in women are different to and more vague than those in men.

The study also found no difference in access to intensive coronary care between people born in Sweden and people born overseas.

"This is very positive news, which sets us apart from many other countries with a high immigrant population", says Dr. Moradi. "However, all in all the study reveals that we have not yet achieved totally equal coronary care in Sweden, and that we therefore need to continue striving towards this end."

The study was financed by grants from the Swedish Council for Working Life and Social Research (FAS 2008-1128) and Karolinska Institutet's doctoral education funds.


Likelihood of treatment in a coronary care unit for a first-time myocardial infarction in relation to sex, country of birth and socioeconomic position in Sweden.
Yang D, James S, de Faire U, Alfredsson L, Jernberg T, Moradi T
PLoS ONE 2013 ;8(4):e62316