{
  "abstract": "Background: Despite the prominent economic burden of coronary care, detailed analyses of factors associated with expenditure in developing nations remain sparse. Objectives: This study aimed to provide such analyses using data from a national cohort of patients undergoing invasive coronary angiography (ICA). Methods: Patient data and billable services were retrieved from the Iran Health Insurance Organization (IHIO) database. Data from 158584 hospitalizations were analyzed. A multi-pollutant index was constructed using weighted quantile sum regression. Hospital case volume and provincial ICA rates were modeled using generalized linear models. Three-tier (patient, hospital, and province) generalized linear mixed models were devised for inpatient costs, revascularization odds, and length of stay (LOS). Results: 17.0% of episodes pertained to acute coronary syndrome. Median inpatient cost was PPP$2033. Interventional services accounted for the largest share of costs (37.1%). Out-of-pocket expenditure was 16.6%. Revascularization was performed in 47.2% of hospitalizations. Ambient pollution, lower socioeconomic deprivation, and higher capacity (active beds and angiography devices) were associated with provincial ICA rates. Male sex and older patients had higher revascularization odds, prolonged stays, and incurred higher costs. Procedure complexity (Cost Ratio: 4.37; 95% CI 4.34–4.39) was a major predictor of costs, along with private ownership, heart center status, and weekend hospitalization. Non-cardiac hospitalizations had prolonged LOS. Less deprived provinces had higher revascularization odds for chronic indications. Conclusions: ICA utilization, outcomes, and costs in Iran were found to be significantly associated with clinical complexity, institutional characteristics, regional capacity, and environmental exposures. These findings are critical for identifying future funding and research priorities.",
  "abstract_shown": true,
  "affiliations": [
    "National Center for Health Insurance Research, Tehran, Iran",
    "School of Medicine, Tehran University of Medical Sciences, Tehran, Iran",
    "Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran",
    "Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran",
    "Pediatric Psychiatry Department, School of Medicine, Imam Khomeini Hospital, Tehran, Iran",
    "Pediatric Neurology Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran",
    "Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Institute, Tehran, Iran"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Seyed Sahab Aarabi"
    },
    {
      "affs": [
        1
      ],
      "name": "Farbod Semnani"
    },
    {
      "affs": [
        2
      ],
      "name": "Kiavash Semnani"
    },
    {
      "affs": [
        3
      ],
      "name": "Shirin Esmaeili"
    },
    {
      "affs": [
        4
      ],
      "name": "Rajabali Daroudi"
    },
    {
      "affs": [
        5
      ],
      "name": "Mehdi Rezaei"
    },
    {
      "affs": [
        6
      ],
      "name": "Mohammad Effatpanah"
    },
    {
      "name": "Mohamad Mehdi Nasehi"
    },
    {
      "name": "Majid Haghjoo"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7hhgy66htm1et.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0356496",
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  "id": "7hhgy66htm1et",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0356496",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Coronary Interventions and Diagnostics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Cardiology/Cardiovascular medicine/Cardiovascular diseases/Coronary heart disease"
    ],
    [
      "plos",
      "/Medicine and health sciences/Cardiology/Cardiovascular medicine/Cardiovascular imaging/Angiography"
    ],
    [
      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/Cardiovascular imaging/Angiography"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health economics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health economics/Health insurance"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Patients/Inpatients"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Cardiovascular diseases/Coronary heart disease"
    ],
    [
      "plos",
      "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Cardiovascular imaging/Angiography"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Cardiovascular procedures/Coronary artery bypass grafting"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Cardiovascular procedures/Revascularization"
    ],
    [
      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Cardiovascular procedures/Revascularization/Coronary revascularization"
    ],
    [
      "plos",
      "/Medicine and health sciences/Vascular medicine/Coronary heart disease"
    ],
    [
      "plos",
      "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Cardiovascular imaging/Angiography"
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      "/Social sciences/Economics/Health economics/Health insurance"
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  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0356496&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-03",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/7hhgy66htm1et.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:56Z",
      "native_id": "10.1371/journal.pone.0356496",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0356496"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:cardiovascular diseases",
      "subfield": "cardiovascular"
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    {
      "field": "medicine",
      "origin": "plos:diagnostic radiology",
      "subfield": "imaging"
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    {
      "field": "medicine",
      "origin": "plos:surgical and invasive medical procedures",
      "subfield": "surgery"
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  "title": "Economic drivers and systemic disparities in invasive coronary angiography: Insights from a national claims database",
  "title_text": "Economic drivers and systemic disparities in invasive coronary angiography: Insights from a national claims database",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:56Z",
  "url": "https://research.draconitic.com/paper/7hhgy66htm1et",
  "venue": "PLOS One",
  "versions": []
}