More evidence that wealth equals health

Socioeconomic status is an independent predictor of disease across a wide breadth of conditions. In this study, David Alter and colleagues report it is also a determinant in the use of angiography after acute myocardial infarction (AMI).

The authors analyzed physician payment claims, hospital discharge abstracts and vital status data for 47 000 Ontario patients who had an AMI between April 1994 and March 1997. They found that angiography rates rose progressively in lockstep with increases in neighbourhood income, irrespective of hospital or geographic characteristics. The study challenges the notion that angiography might be less common among poorer Canadians simply because they live in neighbourhoods near nonteaching hospitals that have no catheterization capacity and few specialists, since these factors did not affect the availability of angiography for wealthier Canadians.

"These findings suggest that such disparities are unlikely to be remedied by an increase in the overall availability of angiography or by redistribution of angiography resources to less affluent neighbourhoods," conclude the authors.

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