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Heart attack rates vary by province, researchers find

When it comes to heart attacks, where you live and how much you earn seem to matter more than how you live.

New data from the Canadian Institute for Health Information show that the rate of heart attacks in Canada's lowest-income neighborhoods was 255 per 100,000 population, compared to 186 per 100,000 in the most affluent ones. That is a 37 per cent difference.

Moreover, there is a two-fold variation in the rate of heart attacks among provinces, ranging from 169 per 100,000 population in B.C. to 347 per 100,000 in Newfoundland and Labrador.

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"Important gaps in heart health still exist between socio-economic groups, as well as between geographic regions in Canada," said Indra Pulcins, director of indicators and performance measurement at CIHI.

"There are a lot of factors that come into play," she said. "But one thing we do know is where there is variation, there is potential for improvement."

Last year, 66,707 Canadians were hospitalized for treatment of an acute myocardial infarction (the medical term for a heart attack), including 2,266 who suffered more than one AMI.

The average age of heart attack sufferers is 71; just over 35 per cent are women. About one-third of patients underwent revascularization - meaning bypass surgery or angioplasty. Province of residence had the most significant impact on heart attack rates, followed by neighbourhood income; they were more impactful than risk factors cited traditionally like diet and exercise.

The good news, according to the report, is that regardless of a person's income or place of residence, the care they received after a heart attack and their outcomes were similar.

For example, 8.3 per cent of patients who are hospitalized for treatment of a heart attack died within 30 days of admission. There is virtually no difference in the rate when it is analyzed by socio-economic group. (Hospital mortality is often used as a crude measure of quality of care.)

However, heart attack patients from the most affluent neighbourhoods are slightly more likely to get bypass surgery or angioplasty. The difference between residents of low-income and high-income neighbourhoods is seven per cent.

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Conversely, 5.2 per cent of patients from the least-affluent areas were re-admitted to hospital after treatment for a heart attack, compared to 4.7 per cent of those in wealthier areas.

The new report, Health Indicators 2010, includes more than 40 measures of health and health system performance in Canada. CIHI has published an annual report on health disparities for the past decade. This year, the focus was on two common health issues: Heart attacks and hysterectomies.

Almost 47,000 women underwent a hysterectomy (the surgical removal of the uterus) in Canada last year but, again, the rates varied markedly by province.

B.C. had the lowest rate, 311 per 100,000 women aged 20 and older, while PEI had the highest rate, 512 per 100,000.

Hysterectomy rates were lowest in low-income and high-income neighbourhoods, and highest in middle-income areas of the country.

The most significant variation, however, was between rural and urban areas with women living in rural areas 46 per cent more likely to undergo the surgical procedure.

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Menstrual disorders like heavy periods were the principal reason for hysterectomies in rural areas while uterine fibroids were the main reason in urban areas.

"This points to differences in clinical practice, not differences in health," said Dr. Vyta Senikas, associate executive vice-president of the Society of Obstetricians and Gynecologists of Canada.

She said physicians in rural areas are not practicing bad medicine but, rather, have limitations such as lacking equipment to do alternative procedures that is available in urban, teaching hospitals. For example, women with menstrual disorders can undergo cauterization or laser treatment of the uterus in big hospitals, but that option is not available in more isolated areas.

The Canadian Institute for Health Information is a not-for-profit, independent organization that collects and analyzes information on health and health care in Canada and makes it publicly available. It is funded by the federal, provincial and territorial governments.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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