Inequality in treatment use among elderly patients with acute myocardial infarction: USA, Belgium and Quebec

<p>Abstract</p> <p>Background</p> <p>Previous research has provided evidence that socioeconomic status has an impact on invasive treatments use after acute myocardial infarction. In this paper, we compare the socioeconomic inequality in the use of high-technology diagnosis and treatment after acute myocardial infarction between the US, Quebec and Belgium paying special attention to financial incentives and regulations as explanatory factors.</p> <p>Methods</p> <p>We examined hospital-discharge abstracts for all patients older than 65 who were admitted to hospitals during the 1993–1998 period in the US, Quebec and Belgium with a primary diagnosis of acute myocardial infarction. Patients' income data were imputed from the median incomes of their residential area. For each country, we compared the risk-adjusted probability of undergoing each procedure between socioeconomic categories measured by the patient's area median income.</p> <p>Results</p> <p>Our findings indicate that income-related inequality exists in the use of high-technology treatment and diagnosis techniques that is not justified by differences in patients' health characteristics. Those inequalities are largely explained, in the US and Quebec, by inequalities in distances to hospitals with on-site cardiac facilities. However, in both Belgium and the US, inequalities persist among patients admitted to hospitals with on-site cardiac facilities, rejecting the hospital location effect as the single explanation for inequalities. Meanwhile, inequality levels diverge across countries (higher in the US and in Belgium, extremely low in Quebec).</p> <p>Conclusion</p> <p>The findings support the hypothesis that income-related inequality in treatment for AMI exists and is likely to be affected by a country's system of health care.</p

A meta-analysis of correlated behaviours with implications for behavioural syndromes: Mean effect size, publication bias, phylogenetic effects and the role of mediator variables

In evolutionary and behavioural ecology, increasing attention is being paid to the fact that functionally distinct behaviours are often not independent from each other. Such phenomenon is labelled as behavioural syndrome and is usually demonstrated by phenotypic correlations between behaviours like activity, exploration, aggression and risk-taking across individuals in a population. However, published studies disagree on the strength, and even on the existence of such relationships. To make general inferences from this mixed evidence, we quantitatively reviewed the literature using modern meta-analytic approaches. Based on a large dataset, we investigated the overall relationship between behaviours that are expected to form a syndrome and tested which factors can mediate heterogeneities in study outcomes. The average strength of the phenotypic correlation between behaviours was weak; we found no effect of the phylogeny of species but did observe significant publication bias. However, even accounting for this bias, the mean effect size was positive and statistically different from zero (r = 0. 198). Effect sizes showed considerable heterogeneity within species, implying a role for population-specific adaptation to environmental factors and/or between-study differences in research design. There was a significant positive association between absolute effect size and repeatability of behaviours, suggesting that within-individual variation of behavioural traits can set up an upper limit for the strength of the detected phenotypic correlations. Moreover, spatial overlap between the contexts in which different behaviours were assayed increased the magnitude of the association. The small effect size for the focal relationship implies that a huge sample size would be required to demonstrate a correlation between behaviours with sufficient statistical power, which is fulfilled only in very few studies. This suggests that behavioural syndromes often remain undetected and unpublished. Collectively, our meta-analysis revealed a number of points that might be worth to consider in the future study of behavioural syndromes. © 2012 The Author(s).Peer Reviewe