Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan
Abstract Background Variation in health care delivery among regions and hospitals has been observed worldwide and reported to have resulted in health inequalities. Regional variation of percutaneous coronary intervention (PCI) was previously reported in Japan. This study aimed to assess the small-ar...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-021-01415-4 |
| _version_ | 1818416296878931968 |
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| author | Yunfei Li Akira Babazono Aziz Jamal Takako Fujita Shinichiro Yoshida Sung-A Kim |
| author_facet | Yunfei Li Akira Babazono Aziz Jamal Takako Fujita Shinichiro Yoshida Sung-A Kim |
| author_sort | Yunfei Li |
| collection | DOAJ |
| description | Abstract Background Variation in health care delivery among regions and hospitals has been observed worldwide and reported to have resulted in health inequalities. Regional variation of percutaneous coronary intervention (PCI) was previously reported in Japan. This study aimed to assess the small-area and hospital-level variations and to examine the influence of patient and hospital characteristics on the use of PCI. Methods Data provided by the Fukuoka Prefecture Latter-stage Elderly Insurance Association was used. There were 11,821 patients aged ≥65 years with acute coronary syndromes who were identified from 2015 to 2017. Three-level multilevel logistic regression analyses were performed to quantify the small-area and hospital variations, as well as, to identify the determinants of PCI use. Results The results showed significant variation (δ2 = 0.744) and increased PCI use (MOR = 2.425) at the hospital level. After controlling patient- and hospital-level characteristics, a large proportional change in cluster variance was found at the hospital level (PCV 14.7%). Fixed-effect estimation results showed that females, patients aged ≥80 years old, hypertension and dyslipidemia had significant association with the use of PCI. Hospitals with high physician density had a significantly positive relationship with PCI use. Conclusions Patients receiving care in hospitals located in small areas have equitable access to PCI. Hospital-level variation might be originated from the oversupply of physicians. A balanced number of physicians and beds should be taken into consideration during healthcare allocation. A treatment process guideline on PCI targeting older patients is also needed to ensure a more equitable access for healthcare resources. |
| first_indexed | 2024-12-14T11:48:38Z |
| format | Article |
| id | doaj.art-53d3956f4e0e4ee6b6de4b7757a11a21 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-14T11:48:38Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-53d3956f4e0e4ee6b6de4b7757a11a212022-12-21T23:02:28ZengBMCInternational Journal for Equity in Health1475-92762021-03-0120111310.1186/s12939-021-01415-4Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, JapanYunfei Li0Akira Babazono1Aziz Jamal2Takako Fujita3Shinichiro Yoshida4Sung-A Kim5Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu UniversityAbstract Background Variation in health care delivery among regions and hospitals has been observed worldwide and reported to have resulted in health inequalities. Regional variation of percutaneous coronary intervention (PCI) was previously reported in Japan. This study aimed to assess the small-area and hospital-level variations and to examine the influence of patient and hospital characteristics on the use of PCI. Methods Data provided by the Fukuoka Prefecture Latter-stage Elderly Insurance Association was used. There were 11,821 patients aged ≥65 years with acute coronary syndromes who were identified from 2015 to 2017. Three-level multilevel logistic regression analyses were performed to quantify the small-area and hospital variations, as well as, to identify the determinants of PCI use. Results The results showed significant variation (δ2 = 0.744) and increased PCI use (MOR = 2.425) at the hospital level. After controlling patient- and hospital-level characteristics, a large proportional change in cluster variance was found at the hospital level (PCV 14.7%). Fixed-effect estimation results showed that females, patients aged ≥80 years old, hypertension and dyslipidemia had significant association with the use of PCI. Hospitals with high physician density had a significantly positive relationship with PCI use. Conclusions Patients receiving care in hospitals located in small areas have equitable access to PCI. Hospital-level variation might be originated from the oversupply of physicians. A balanced number of physicians and beds should be taken into consideration during healthcare allocation. A treatment process guideline on PCI targeting older patients is also needed to ensure a more equitable access for healthcare resources.https://doi.org/10.1186/s12939-021-01415-4Percutaneous coronary interventionMultilevel analysisSmall area variationHospital variationJapan |
| spellingShingle | Yunfei Li Akira Babazono Aziz Jamal Takako Fujita Shinichiro Yoshida Sung-A Kim Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan International Journal for Equity in Health Percutaneous coronary intervention Multilevel analysis Small area variation Hospital variation Japan |
| title | Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan |
| title_full | Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan |
| title_fullStr | Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan |
| title_full_unstemmed | Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan |
| title_short | Variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes: a multilevel study in Fukuoka, Japan |
| title_sort | variation in the use of percutaneous coronary interventions among older patients with acute coronary syndromes a multilevel study in fukuoka japan |
| topic | Percutaneous coronary intervention Multilevel analysis Small area variation Hospital variation Japan |
| url | https://doi.org/10.1186/s12939-021-01415-4 |
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