{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T08:06:42Z","timestamp":1770883602078,"version":"3.50.1"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2014,12,17]]},"abstract":"\n Background<\/jats:title>\n \n The rapidly changing landscape of percutaneous coronary intervention provides a unique model for examining disparities over time. Previous studies have not examined socioeconomic inequalities in the current era of drug eluting stents (\n DES<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We analyzed 835\u00a0070 hospitalizations for acute coronary syndrome (\n ACS<\/jats:styled-content>\n ) from the Healthcare Cost and Utilization Project across all insurance types from 2008 to 2011, examining whether quality of care and outcomes for patients with\n ACS<\/jats:styled-content>\n differed by income (based on zip code of residence) with adjustment for patient characteristics and clustering by hospital. We found that lower\u2010income patients were less likely to receive an angiogram within 24\u00a0hours of a\n ST<\/jats:styled-content>\n elevation myocardial infarction (\n STEMI<\/jats:styled-content>\n ) (69.5% for\n IQ<\/jats:styled-content>\n 1 versus 73.7% for\n IQ<\/jats:styled-content>\n 4,\n P<\/jats:italic>\n <0.0001,\n OR<\/jats:styled-content>\n 0.79 [0.68 to 0.91]) or within 48\u00a0hours of a Non\u2010\n STEMI<\/jats:styled-content>\n (47.6% for\n IQ<\/jats:styled-content>\n 1 versus 51.8% for\n IQ<\/jats:styled-content>\n 4,\n P<\/jats:italic>\n <0.0001,\n OR<\/jats:styled-content>\n 0.86 [0.75 to 0.99]). Lower income was associated with less use of a\n DES<\/jats:styled-content>\n (64.7% for\n IQ<\/jats:styled-content>\n 1 versus 71.2% for\n IQ<\/jats:styled-content>\n 4,\n P<\/jats:italic>\n <0.0001,\n OR<\/jats:styled-content>\n 0.83 [0.74 to 0.93]). However, no differences were found for coronary artery bypass surgery. Among\n STEMI<\/jats:styled-content>\n patients, lower\u2010income patients also had slightly increased adjusted mortality rates (10.8% for\n IQ<\/jats:styled-content>\n 1 versus 9.4% for\n IQ<\/jats:styled-content>\n 4,\n P<\/jats:italic>\n <0.0001,\n OR<\/jats:styled-content>\n 1.17 [1.11 to 1.25]). After further adjusting for time to reperfusion among\n STEMI<\/jats:styled-content>\n patients, mortality differences across income groups decreased.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n For the most well accepted procedural treatments for\n ACS<\/jats:styled-content>\n , income inequalities have faded. However, such inequalities have persisted for\n DES<\/jats:styled-content>\n use, a relatively expensive and until recently, controversial revascularization procedure. Differences in mortality are significantly associated with differences in time to primary\n PCI<\/jats:styled-content>\n , suggesting an important target for understanding why these inequalities persist.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.114.001029","type":"journal-article","created":{"date-parts":[[2014,11,15]],"date-time":"2014-11-15T04:17:59Z","timestamp":1416025079000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":65,"title":["Socioeconomic Inequalities in Quality of Care and Outcomes Among Patients With Acute Coronary Syndrome in the Modern Era of Drug Eluting Stents"],"prefix":"10.1161","volume":"3","author":[{"given":"Celina M.","family":"Yong","sequence":"first","affiliation":[{"name":"Stanford University\/Stanford Cardiovascular Institute, Palo Alto, CA"},{"name":"VA Palo Alto Health Care System, Palo Alto, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freddy","family":"Abnousi","sequence":"additional","affiliation":[{"name":"Stanford University\/Stanford Cardiovascular Institute, Palo Alto, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven M.","family":"Asch","sequence":"additional","affiliation":[{"name":"VA Palo Alto Health Care System, Palo Alto, CA"},{"name":"Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Stanford University\/Stanford Cardiovascular Institute, Palo Alto, CA"},{"name":"VA Palo Alto Health Care System, Palo Alto, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","volume-title":"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care","author":"The Institute of Medicine Report","year":"2002","unstructured":"The Institute of Medicine Report . 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