Health inequities in cardiac care and cardiovascular guideline concordance in Australian migrant populations: data correlation for culturally and linguistically diverse populations (DatCALD) project
Authors: Dalinjong P A , Glover J , Oommen A , Wechkunanukul K 
Published: October 2024

Abstract

Background
Evidence of inequities in acute cardiac care and concordance with cardiovascular guidelines in migrant populations have not been well documented in Australia. Additionally, knowledge of correlations between clinical data and population health data of these marginalised groups is seriously lacking.

Purpose
To establish an interactive population health atlas and perform data correlations to determine health inequities in cardiac care provision in emergency departments (EDs) and examine guideline concordance in migrant populations.

Methods
This study correlated population health data derived from public health surveillance systems with the clinical data of migrant populations in Australia. The interactive atlas has been established and data correlations between relevant variables have been produced. Degree of correlations were presented as a correlation coefficient (r).

Results
The evidence revealed a strong relationship between migrant status and poor cardiac care provision. Migrant populations who were born overseas in non-English-speaking (NES) countries were less likely to access universal health coverage in Australia (Medicare) and were more likely to live with socioeconomic disadvantage (r= 0.24). Birthplaces of migrants were associated with longer processing time for cardiac care in ED, including time to meet an ED doctor and total ED stay time (Figure 1). Migrant populations were less likely to receive cardiac care at triage within the recommended timeframe of 10 minutes (r= -0.35), whereas the Australian-born group were more likely to reach ED treatment within 10 minutes (r= -0.52). Interestingly, migrants who were born in English speaking countries had the strongest relationship with an ED stay longer than the recommended time of four hours (r= -0.42).
An association between migrant populations and non-concordance with guidelines for management of chest pain was evident (Figure 2). The population born overseas in NES countries, resident in Australia ≥ 5 years had the strongest correlation with non-concordance (r= 0.50); whereas the Australian-born population were the most likely to meet the concordance guideline. The evidence suggested that permanent migrants entering Australia between 2000-2006 under family and skill stream visas have a higher likelihood of non-concordance with guidelines for chest pain management (r= 0.50) compared to those of this group who arrived in Australia after 2006.

Conclusions
Health inequities in cardiac care in ED and concordance with cardiovascular guidelines have been found to be associated with migrant status at varying degrees, related to their birthplace and duration of residency. Universal health coverage and sociocultural factors are related to those health inequities. Addressing these determinants of health, normalizing cultural competence and increase health service accessibility are recommended to promote and sustain health equities and wellbeing in these disadvantaged populations.Birthplace and ED provisionBirthplace and non-concordance