© 1997 by European Journal of Public Health
INEQUALITIES IN HEALTH |
Socioeconomic and gender inequities in access to coronary artery bypass grafting in Finland
ILMO KESKIMÄKI1,, SEPPO KOSKINEN2, MARJO SALINTO1 and SEPPO ARO1
1 Health Services Research Unit, Stakes, National Research and Development Centre for Welfare and Health Helsinki, Finland
2 Population Research Unit, Department of Sociology, University of Helsinki Helsinki, Finland
llmo Keskim
ki, senior researcher, MD, Stakes, National Research and Development Centre for Welfare and Health, Health Services Research Unit, P.O. Box 220, FIN–00531 Helsinki, Finland, tel. +358 9 3967 2256, fax 
358 9 3967 2485
This study describes socioeconomic and gender differences in the use of coronary artery bypass grafting in relation to the need and regional supply of these operations in Finland. We established the rates of bypass operations performed for patients aged 40–69 years by social class, education and disposable income and compared the operation rates to mortality from and risk of hospitalization due to coronary heart disease in the same socioeconomic groups. The data on bypass operations and hospital use were derived from a data set linking individually the 1988 Finnish Hospital Discharge Register and the 1987 population census. The data on coronary heart disease mortality came from a similar linkage scheme of the 1986–1991 cause of death registers and the 1985 census. Among men, coronary bypass was more common for those in high socioeconomic categories for the variables analysed and in all age groups. These disparities in operation rates were inverse to the socioeconomic gradients in mortality from and risk of hospitalization due to coronary heart disease. Among women, the socioeconomic trends in surgery rates were not similar for all socioeconomic variables, but in relation to need showed higher use among the better-off. In relation to hospitalization due to coronary heart disease, women received proportionally less surgery than men. In hospital districts with the lowest overall bypass surgery rates, the distribution of operations more clearly favoured men and high socioeconomic groups than elsewhere. In the late 1980s clear discrepancies existed between the need for and use of coronary artery bypass surgery across socioeconomic groups in Finland. Some evidence also suggested corresponding inequities between genders.
Keywords: equity in health care, coronary artery bypass grafting, coronary heart disease, socioeconomic factors, Finland
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