SOCIOECONOMIC AND GENDER INEQUITIES IN ACCESS TO CORONARY-ARTERY BYPASS-GRAFTING IN FINLAND

This study describes socioeconomic and gender differences in the use o f coronary artery bypass grafting in relation to the need and regional supply of these operations in Finland, We established the rates of by pass operations performed for patients aged 40-69 years by social clas s, education and disposable income and compared the operation rates to mortality from and risk of hospitalization due to coronary heart dise ase in the same socioeconomic groups, The data on bypass operations an d hospital use were derived from a data set linking individually the 1 988 Finnish Hospital Discharge Register and the 1987 population census , The data on coronary heart disease mortality came from a similar lin kage scheme of the 1986-1991 cause of death registers and the 1985 cen sus, Among men, coronary bypass was more common for those in high soci oeconomic categories for the variables analysed and in all age groups, These disparities in operation rates were inverse to the socioeconomi c gradients in mortality from and risk of hospitalization due to coron ary heart disease, Among women, the socioeconomic trends in surgery ra tes were not similar for all socioeconomic variables, but in relation to need showed higher use among the better-off, In relation to hospita lization due to coronary heart disease, women received proportionally less surgery than men, In hospital districts with the lowest overall b ypass surgery rates, the distribution of operations more clearly favou red men and high socioeconomic groups than elsewhere, In the late 1980 s clear discrepancies existed between the need for and use of coronary artery bypass surgery across socioeconomic groups in Finland, Some ev idence also suggested corresponding inequities between genders.