Li Zhang - Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
Alan Geater - Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
Edward McNeil - Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
Yun Lin - Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
Si Liu - Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand
Heng Luo - People’s Hospital of Chuxiong Prefecture, Yunnan, China
Yuan Wang - Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
Shao Wen - Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China

Background  As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. Methods  Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time.Results  A total of ۳۷۶ STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR] = ۰.۴۷, ۹۵% CI: ۰.۲۸-۰.۸۰, P = .۰۰۴) and timely reperfusion therapy (OR = ۰.۳۲, ۹۵% CI: ۰.۱۴-۰.۷۰, P = .۰۰۵). Rural residents were less likely to present to hospital promptly than urban residents (HR = ۰.۶۵, ۹۵% CI = ۰.۵۲-۰.۸۲, P < .۰۰۱). In the first ۳ hours of percutaneous coronary intervention (PCI) reperfusion delay and first ۶ hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR] = ۰.۴۰, ۹۵% CI: ۰.۲۹-۰.۵۴, P < .۰۰۱) and reperfusion therapy (HR = ۰.۳۷, ۹۵% CI: ۰.۲۵-۰.۵۶, P < .۰۰۱) compared to urban patients. Conclusion  Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.

Health Inequality, Social Determinants, ST-elevation Myocardial Infarction, Reperfusion, Under-Developed Area, Rural-Urban