Evidence map›Paper›PMID 25360759›Full record

Observational studyPloS one2014

Influence of municipality-level mean income on access to aortic valve surgery: a cross-sectional observational study under Japan's universal health-care coverage.

Seitetsu L Lee, Hideki Hashimoto, Takahide Kohro, Hiromasa Horiguchi, Daisuke Koide, Issei Komuro, Kiyohide Fushimi, Tsutomu Yamazaki, Hideo Yasunaga

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Seitetsu L LeeDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Hideki HashimotoDepartment of Health and Social Behavior, The University of Tokyo, Tokyo, Japan.
Takahide KohroDepartment of Clinical Informatics, Jichi Medical University, Tochigi, Japan.
Hiromasa HoriguchiDepartment of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
Daisuke KoideDepartment of Clinical Epidemiology and Systems, The University of Tokyo, Tokyo, Japan.
Issei KomuroDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Kiyohide FushimiDepartment of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan.
Tsutomu YamazakiClinical Research Support Center, The University of Tokyo, Tokyo, Japan.
Hideo YasunagaDepartment of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundUniversal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan's health-care system, which is mainly publicly funded.

methodsWe chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients' clinical status.

resultsWe found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69-1.03) or in-hospital mortality (1.00; 0.68-1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34-0.71).

conclusionsUnder Japan's current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care.

Indexed as

IncomeAgedAged, 80 and overAortic ValveAortic Valve StenosisCitiesDelivery of Health CareFemaleHospital MortalityHumansJapanSocial ClassUniversal Health InsuranceUrban Population

Identifiers

PMID25360759
PMCPMC4215927

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.