Background
Methods
Record selection and data collection
Surgery | Initial sample | Records with missing values for the education variable | Missing values recovery from record linkage between the HDDs | Missing values recovery from record linkage with the Turin municipal registry | Providers with few cases | Waiting times higher than the 99thpercentile | Final sample |
---|---|---|---|---|---|---|---|
CABG
| 4,465 | 1,543 | 926 | 56 | 2 | 40 | 3,862 |
Angioplasty
| 9,973 | 5,115 | 1,770 | 893 | 16 | 77 | 7,428 |
Coronarography
| 26,307 | 12,081 | 4,693 | 1,640 | 36 | 213 | 20,310 |
Endarterectomy
| 4,126 | 2,115 | 731 | 386 | 8 | 33 | 3,087 |
Hip replacement
| 15,982 | 5,462 | 2,245 | 639 | 10 | 134 | 13,260 |
Cholecystectomy
| 17,246 | 4,511 | 732 | 783 | 24 | 143 | 14,083 |
Statistical analysis
Description | Codes/Values |
---|---|
Waiting time from registration to surgery | Integer for number of days |
Education (at surgery time) | Primary school or less (LOW) |
Middle school (MIDDLE) | |
Upper secondary school or higher education (HIGH) | |
Gender | Male |
Female | |
Age groups (at surgery) | <= 54 |
55-64 | |
65-74 | |
> = 75 | |
Year of registration | <2006 |
2006 | |
2007 | |
2008 | |
CCI | 0,1,or 2 (≥2) |
LHA/HT | LHA- City of Turin; LHA - Western Piedmont; LHA - Northern Piedmont; LHA - Southern Piedmont; LHA - Eastern Piedmont; HT - City of Turin; HT - Piedmont Region; Other Hospitals. |
Results
Characteristics of the population
CABG | Angioplasty | Coronarography | Endoarterectomy | Hip replacement | Cholecystectomy | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | |
Education
| ||||||||||||
Low education | 1896 | 49.1 | 3207 | 43.2 | 9375 | 46.2 | 1947 | 63.1 | 7257 | 54.7 | 4757 | 33.8 |
Middle education | 1124 | 29.1 | 2277 | 30.7 | 5987 | 29.5 | 692 | 22.4 | 3882 | 29.3 | 5366 | 38.1 |
High education | 842 | 21.8 | 1944 | 26.2 | 4948 | 24.4 | 448 | 14.5 | 2121 | 16.0 | 3960 | 28.1 |
Gender
| ||||||||||||
Male | 2908 | 75.3 | 5719 | 77.0 | 13983 | 68.8 | 2115 | 68.5 | 5580 | 42.1 | 5407 | 38.4 |
Female | 954 | 24.7 | 1709 | 23.0 | 6327 | 31.2 | 972 | 31.5 | 7680 | 57.9 | 8676 | 61.6 |
Age groups
| ||||||||||||
<55 | 329 | 8.5 | 791 | 10.6 | 2419 | 11.9 | 67 | 2.2 | 1391 | 10.5 | 6041 | 42.9 |
55-64 | 861 | 22.3 | 1897 | 25.5 | 4965 | 24.4 | 404 | 13.1 | 2450 | 18.5 | 3140 | 22.3 |
65-74 | 1610 | 41.7 | 2949 | 39.7 | 7980 | 39.3 | 1290 | 41.8 | 5162 | 38.9 | 3368 | 23.9 |
>74 | 1062 | 27.5 | 1791 | 24.1 | 4946 | 24.4 | 1326 | 43.0 | 4257 | 32.1 | 1534 | 10.9 |
CCI
| ||||||||||||
0 | 2712 | 70.2 | 4494 | 60.5 | 14136 | 69.6 | 2165 | 70.1 | 12477 | 94.1 | 12561 | 89.2 |
1 | 761 | 19.7 | 2253 | 30.3 | 4811 | 23.7 | 645 | 20.9 | 629 | 4.7 | 946 | 6.7 |
2+ | 389 | 10.1 | 681 | 9.2 | 1363 | 6.7 | 277 | 9.0 | 154 | 1.2 | 576 | 4.1 |
Year of registration
| ||||||||||||
<2006 | 72 | 1.9 | 102 | 1.4 | 291 | 1.4 | 115 | 3.7 | 1567 | 11.8 | 610 | 4.3 |
2006 | 1267 | 32.8 | 2368 | 31.9 | 6583 | 32.4 | 1046 | 33.9 | 4342 | 32.7 | 4656 | 33.1 |
2007 | 1304 | 33.8 | 2432 | 32.7 | 6740 | 33.2 | 983 | 31.8 | 4273 | 32.2 | 4803 | 34.1 |
2008 | 1219 | 31.6 | 2526 | 34.0 | 6696 | 33.0 | 943 | 30.5 | 3078 | 23.2 | 4014 | 28.5 |
Location
| ||||||||||||
LHA - City of Turin | 261 | 6.8 | 2355 | 31.7 | 4747 | 23.4 | 375 | 12.1 | 2129 | 16.1 | 1971 | 14.0 |
LHA - Province of Turin | 511 | 6.9 | 900 | 4.4 | 119 | 3.9 | 1306 | 9.8 | 1961 | 13.9 | ||
LHA - Eastern Piedmont | 615 | 15.9 | 734 | 9.9 | 3102 | 15.3 | 105 | 3.4 | 1258 | 9.5 | 1230 | 8.7 |
LHA - Southern Piedmont | 158 | 2.1 | 581 | 2.9 | 57 | 1.8 | 2584 | 19.5 | 1594 | 11.3 | ||
LHA - Northern Piedmont | 922 | 23.9 | 1049 | 14.1 | 3842 | 18.9 | 395 | 12.8 | 2151 | 16.2 | 3060 | 21.7 |
HT – City of Turin | 742 | 19.2 | 1509 | 20.3 | 3275 | 16.1 | 1055 | 34.2 | 1651 | 12.5 | 2477 | 17.6 |
HT - Piedmont Region | 1322 | 34.2 | 1112 | 15.0 | 3863 | 19.0 | 981 | 31.8 | 770 | 5.8 | 921 | 6.5 |
Other Hospitals | 1411 | 10.6 | 869 | 6.2 | ||||||||
Total
| 3862 | 100.0 | 7428 | 100.0 | 20310 | 100.0 | 3087 | 100.0 | 13260 | 100.0 | 14083 | 100.0 |
CABG | Angioplasty | Coronarography | Endarterectomy | Hip replacement | Cholecystectomy | |
---|---|---|---|---|---|---|
Education
| ||||||
None/low Education | 12.0 [11.5,12.5] | 8.0 [7.6,8.4] | 8.0 [7.8,8.2] | 28.0 [26.3,29.7] | 83.0 [80.5,85.5] | 32.0 [30.9,33.1] |
Middle Education | 12.0 [11.4,12.6] | 7.0 [6.5,7.5] | 7.0 [6.7,7.3] | 27.0 [24.1,29.9] | 76.0 [72.8,79.2] | 32.0 [31.0,33.0] |
High Education | 10.0 [9.5,10.5] | 6.0 [5.7,6.3] | 7.0 [6.8,7.2] | 20.0 [17.3,22.7] | 60.0 [55.6,64.4] | 31.0 [29.6,32.4] |
Gender
| ||||||
Male | 11.0 [[10.7,11.4] | 7.0 [6.7,7.3] | 7.0 [6.8,7.2] | 26.0 [24.5,27.5] | 78.0 [75.2,80.8] | 31.0 [30.0,32.0] |
Female | 11.0 [10.4,11.6] | 7.0 [6.6,7.4] | 7.0 [6.8,7.2] | 28.0 [25.7,30.3] | 77.0 [74.7,79.3] | 33.0 [32.1,33.9] |
Age groups
| ||||||
<= 54 | 11.0 [10.0, 12.0] | 7.0 [6.3,7.7] | 8.0 [7.6,8.4] | 22.0 [16.6,28.4] | 74.0 [68.5,79.5] | 33.0 [32.0,34.0] |
55-64 | 11.0 [10.4,11.6] | 7.0 [6.5,7.5] | 7.0 [6.7,7.2] | 24.0 [20.6,27.4] | 83.0 [78.4,87.6] | 33.0 [31.5,34.5] |
65-74 | 12.0 [11.5,12.5] | 7.0 [6.6,7.4] | 7.0 [6.8,7.2] | 26.0 [23.8,28.2] | 84.0 [81.0,87.0] | 32.0 [30.6,33.4] |
> = 75 | 11.0 [10.4,11.6] | 7.0 [6.6,7.4] | 7.0 [6.8,7.2] | 28.0 [26.1,29.9] | 69.0 [66.1,71.9] | 27.0 [25.4,28.6] |
CCI
| ||||||
0 | 11.0 [10.7,11.3] | 7.0 [6.7,7.3] | 7.0 [6.9,7.1] | 24.0 [22.6,25.4] | 76.0 [74.1,77.9] | 32.0 [31.3,32.7] |
1 | 12.0 [11.1,13.0] | 7.0 [6.4,7.6] | 7.0 [6.6,7.4] | 31.0 [27.5,34.5] | 100.0 [92.1,107.9] | 36.0 [33.2,38.8] |
> = 2 | 12.0 [10.6,13.4] | 10.0 [8.6,11.4] | 10.0 [8.9,11.0] | 36.0 [29.4,42.5] | 91.5 [76.0,107.0] | 22.0 [20.2,23.8] |
Year of registration
| ||||||
<2006 | 18.0 [14.4,,21.6] | 34.0 [24.9,43.1] | 36.0 [31.1,40.9] | 85.0 [74.5,95.5] | 194.0 [185.4,202.6] | 76.0 [69.9,82.1] |
2006 | 11.0 [10.6,11.4] | 7.0 [6.6,7.4] | 7.0 [6.8,7.2] | 25.0 [22.7,27.3] | 83.0 [79.9,86.1] | 32.0 [31.0,33.0] |
2007 | 12.0 [11.4,12.6] | 7.0 [6.6,7.4] | 7.0 [6.7,7.3] | 27.0 [24.6,29.4] | 77.0 [74.1,80.0] | 32.0 [30.7,33.3] |
2008 | 11.0 [10.5,11.5] | 7.0 [6.6,7.4] | 7.0 [6.8,7.2] | 24.0 [22.1,25.9] | 41.0 [39.0,43.0] | 28.0 [27.0,29.0] |
LHA
| ||||||
LHA – City of Turin | 7.0 [6.5,7.5] | 6.0 [5.9,6.1] | 5.0 [4.9,5.1] | 22.0 [16.5,27.5] | 50.0 [45.8,54.2] | 36.0 [33.4,38.6] |
LHA – Province of Turin | 29.0 [27.2,30.8] | 28.0 [26.6,29.4] | 20.0 [18.8,21.2] | 79.5 [75.3,83.7] | 35.0 [33.3,36.7] | |
LHA – Eastern Piedmont | 12.0 [11.2,12.8] | 10.0 [8.9,11.1] | 8.0 [7.6,8.4] | 11.0 [9.7,12.3] | 27.5 [24.6,30.3] | 24.0 [22.3,25.7] |
LHA – Southern Piedmont | - | 8.0 [6.9,9.1] | 9.0 [8.1,9.9] | 32.0 [25.5,38.5] | 106.0 [102.2,109.8] | 30.0 [28.7,31.3] |
LHA – Northern Piedmont | 11.0 [10.5,11.5] | 10.0 [9.4,10.6] | 10.0 [9.8,10.2] | 16.0 [14.6,17.4[ | 29.0 [26.7,31.3] | 25.5 [24.8,26.2] |
HT – City of Turin | 11.0 [9.7,12.3] | 8.0 [7.3,8.7] | 13.0 [12.3,13.7] | 34.0 [29.9,38.1] | 121.0 [114.5,127.5] | 38.0 [35.6,40.4] |
HT – Piedmont Region | 13.0 [12.4,13.6] | 4.0 [3.8,4.2] | 4.0 [3.8,4.2] | 33.0 [30.7,35.3] | 132.5 [123.5,141.5] | 52.0 [43.4,60.6] |
Other Hospitals | - | - | - | - | 118.0 [112.4,123.6] | 53.0 [48.6,57.4] |
Total
| 11.0 [10.7,11.3] | 7.0 [6.8,7.2] | 7.0 [6.9,7.1] | 26.0 [24.7,27.3] | 77.0 [75.2,78.8] | 32.0 [31.3,32.7] |
Statistical models
CABG | Angioplasty | Coronarography | Endarterectomy | Hip replacement | Cholecystectomy | |
---|---|---|---|---|---|---|
Education
| ||||||
Low education | 0.940 [0.860 - 1.026] | 0.880 [0.819 - 0.944] | 0.920 [0.883 - 0.958] | 0.660 [0.571 - 0.762] | 0.761 [0.709 - 0.817] | 0.838 [0.788 - 0.892] |
Middle education | 0.927 [0.846 - 1.015] | 0.905 [0.841 - 0.974] | 0.956 [0.920 - 0.993] | 0.745 [0.631 - 0.880] | 0.852 [0.791 - 0.918] | 0.925 [0.875 - 0.978] |
Gender
| ||||||
Male | 1.008 [0.935 - 1.088] | 0.929 [0.879 - 0.982] | 1.004 [0.974 - 1.035] | 1.086 [1.005 - 1.174] | 0.980 [0.946 - 1.015] | 1.043 [1.008 - 1.080] |
Age groups
| ||||||
<55 | 1.148 [1.009 - 1.307] | 0.979 [0.898 - 1.068] | 0.926 [0.880 - 0.974] | 1.065 [0.825 - 1.374] | 0.927 [0.869 - 0.989] | 0.824 [0.774 - 0.877] |
55-64 | 1.100 [1.002 - 1.209] | 0.962 [0.900 - 1.028] | 0.960 [0.921 - 0.999] | 1.046 [0.934 - 1.172] | 0.847 [0.804 - 0.891] | 0.833 [0.782 - 0.887] |
65-74 | 1.019 [0.942 - 1.102] | 0.956 [0.901 - 1.014] | 0.976 [0.942 - 1.012] | 1.015 [0.939 - 1.097] | 0.839 [0.795 - 0.885] | 0.856 [0.805 - 0.909] |
CCI
| ||||||
1 | 0.989 [0.908 - 1.078] | 0.881 [0.837 - 0.929] | 0.886 [0.857 - 0.917] | 0.787 [0.692 - 0.894] | 0.917 [0.846 - 0.995] | 0.876 [0.799 - 0.962] |
> = 2 | 1.004 [0.895 - 1.127] | 0.681 [0.614 - 0.755] | 0.693 [0.646 - 0.743] | 0.855 [0.751 - 0.973] | 0.763 [0.592 - 0.984] | 1.785 [1.596 - 1.997] |
Year of registration
| ||||||
<2006 | 0.713 [0.562 - 0.906] | 0.348 [0.265 - 0.458] | 0.406 [0.361 - 0.457] | 0.229 [0.162 - 0.324] | 0.272 [0.245 - 0.301] | 0.406 [0.358 - 0.459] |
2007 | 0.876 [0.810 - 0.947] | 1.025 [0.968 - 1.085] | 0.992 [0.958 - 1.026] | 0.967 [0.855 - 1.095] | 1.118 [1.050 - 1.189] | 0.929 [0.892 - 0.967] |
2008 | 0.915 [0.845 - 0.991] | 0.946 [0.886 - 1.011] | 1.018 [0.984 - 1.054] | 1.022 [0.903 - 1.158] | 1.779 [1.659 - 1.908] | 1.114 [1.068 - 1.163] |
Location
| ||||||
LHA - Province of Turin | 0.235 [0.206 - 0.267] | 0.237 [0.216 - 0.260] | 0.457 [0.319 - 0.655] | 0.607 [0.554 - 0.666] | 1.161 [1.072 - 1.257] | |
LHA - Eastern Piedmont | 0.326 [0.268 - 0.398] | 0.540 [0.495 - 0.589] | 0.613 [0.585 - 0.643] | 1.867 [1.500 - 2.323] | 1.334 [1.243 - 1.432] | 1.491 [1.388 - 1.603] |
LHA - Southern Piedmont | 0.705 [0.599 - 0.830] | 0.490 [0.437 - 0.548] | 0.964 [0.729 - 1.276] | 0.369 [0.340 - 0.400] | 1.329 [1.221 - 1.448] | |
LHA - Northern Piedmont | 0.467 [0.396 - 0.551] | 0.518 [0.480 - 0.559] | 0.533 [0.510 - 0.558] | 1.411 [1.222 - 1.629 | 1.248 [1.175 - 1.326] | 1.621 [1.511 - 1.738] |
HT - City of Turin | 0.472 [0.395 - 0.565] | 0.580 [0.543 - 0.620] | 0.383 [0.363 - 0.405] | 0.594 [0.526 - 0.671] | 0.355 [0.323 - 0.389] | 0.917 [0.864 - 0.973] |
HT - Piedmont Region | 0.478 [0.414 - 0.552] | 1.600 [1.455 - 1.759] | 1.181 [1.120 - 1.245] | 0.617 [0.535 - 0.711] | 0.392 [0.348 - 0.443] | 0.728 [0.652 - 0.812] |
Other Hospitals | 0.318 [0.288 - 0.352] | 0.624 [0.558 - 0.698] |
CABG | Angioplasty | Coronarography | Endarterectomy | Hip replacement | Cholecystectomy | |
---|---|---|---|---|---|---|
Education
| ||||||
Low education | 1.004 [1.001 - 1.006] | 1.001 [1.000 - 1.003] | 1.005 [1.002 - 1.007] | 1.001 [1.001 - 1.002] | 1.001 [1.000 - 1.002] | |
Middle education | 1.002 [1.000 - 1.005] | 1.004 [1.001 - 1.007] | 1.001 [1.000 - 1.001] | 1.001 [1.000 - 1.002] | ||
Age groups (years)
| ||||||
65-74 | 1.001 [1.000 - 1.001] | |||||
CCI
| ||||||
1 | 1.002 [1.000 - 1.004] | 1.001 [1.000 - 1.002] | ||||
> = 2 | 1.004 [1.001 - 1.007] | 1.004 [1.002 - 1.006] | 1.002 [1.000 - 1.004] | 0.997 [0.995 - 0.999] | ||
Year of registration
| ||||||
<2006 | 1.004 [1.000 - 1.009] | 1.012 [1.009 - 1.016] | 1.003 [1.002 - 1.003] | 1.001 [1.001 - 1.002] | ||
2007 | 1.003 [1.001 - 1.005] | 1.000 [0.999 - 1.000] | ||||
2008 | 1.004 [1.001 - 1.006] | 1.004 [1.001 - 1.006] | ||||
Location
| ||||||
LHA - Province of Turin | 1.012 [1.009 - 1.015] | 1.010 [1.008 - 1.012] | 1.060 [1.046 - 1.075] | 1.004 [1.003 - 1.004] | 1.001 [1.000 - 1.002] | |
LHA - Eastern Piedmont | 1.030 [1.021 - 1.040] | |||||
LHA - Southern Piedmont | 1.007 [1.003 - 1.011] | 1.005 [1.005 - 1.006] | 1.005 [1.004 - 1.006] | |||
LHA - Northern Piedmont | 1.022 [1.015 - 1.030] | 1.001 [1.000 - 1.002) | ||||
HT - City of Turin | 0.992 [0.986 - 0.997] | 1.006 [1.005 - 1.008] | 1.004 [1.003 - 1.004] | |||
HT - Piedmont Region | 0.972 [0.964 - 0.979] | 0.979 [0.976 - 0.982] | 1.003 [1.001 - 1.004] | 1.004 [1.004 - 1.005] | 1.003 [1.002 - 1.004] | |
Other Hospitals | 1.006 [1.005 - 1.006] | 1.004 [1.003 - 1.005] |
Sensitivity analysis
-
The ascertained education level;
-
The education level attributed through record linkage;
-
The missing education level not attributed through record linkage.