| dc.contributor.author | Hassan, Ansar. | en_US |
| dc.date.accessioned | 2014-10-21T12:37:52Z | |
| dc.date.available | 2007 | |
| dc.date.issued | 2007 | en_US |
| dc.identifier.other | AAINR27160 | en_US |
| dc.identifier.uri | http://hdl.handle.net/10222/54863 | |
| dc.description | The province of Nova Scotia has among the highest prevalence rates of ischemic heart disease (IHD) in Canada. Despite the considerable resources invested in the treatment of IHD in Nova Scotia, very little is known regarding access to cardiac care and outcomes among patients with IHD in this province. The purpose of this thesis is to gain insight into the complex relationships underlying sex, socioeconomic status (SES), geography and cardiovascular care in Nova Scotia through the use of rich observational and administrative data and traditional as well as non-traditional statistical methodologies. | en_US |
| dc.description | In patients undergoing coronary artery bypass grafting (CABG), women had worse long-term rates of mortality and/or readmission when compared to men following adjustment for baseline differences in co-morbid disease and clinical presentation. In patients admitted to hospital with an acute myocardial infarction (MI) in Nova Scotia, place of residence in areas remote from the single tertiary cardiac care centre in Nova Scotia emerged as an independent predictor of lower rates of cardiac catheterization within the first six months following admission as well as higher long-term rates of readmission to hospital for any cardiac cause. SES, as defined by income and education level, did not emerge as an independent predictor. This theme re-emerged when the association between SES, geography and intermediate-term outcomes was explored in patients undergoing CABG. Following adjustment for differences between patients, place of residence was found to be an independent predictor of higher rates of readmission to hospital for any cardiac cause over time following CABG. Finally, with the support of hierarchical logistic regression modeling and detailed individual- and area-level data, it was found that lower individual-level income in addition to place of residence emerged as independent predictors of increased cardiac readmission. | en_US |
| dc.description | The negative effect of female sex, SES and geography on access to cardiac care and cardiovascular outcomes in Nova Scotia has been clearly demonstrated in this thesis. Further research into the causal mechanisms underlying these inequities is required in order to determine the causal mechanisms underlying these inequities. This will allow for the development of interventions designed specifically at minimizing these disparities. | en_US |
| dc.description | Thesis (Ph.D.)--Dalhousie University (Canada), 2007. | en_US |
| dc.language | eng | en_US |
| dc.publisher | Dalhousie University | en_US |
| dc.publisher | | en_US |
| dc.subject | Health Sciences, Public Health. | en_US |
| dc.title | Geographic and socioeconomic determinants of health services utilization and clinical outcomes in ischemic heart disease patients in Nova Scotia. | en_US |
| dc.type | text | en_US |
| dc.contributor.degree | Ph.D. | en_US |
