Equity in healthcare for coronary heart disease, Wales (UK) 2004–2010: A population-based electronic cohort study

Despite substantial falls in coronary heart disease (CHD) mortality in the United Kingdom (UK), marked socioeconomic inequalities in CHD risk factors and CHD mortality persist. We investigated whether inequity in CHD healthcare in Wales (UK) could contribute to the observed social gradient in CHD mortality. Linking data from primary and secondary care we constructed an electronic cohort of individuals (n = 1199342) with six year follow-up, 2004–2010. We identified indications for recommended CHD interventions, measured time to their delivery, and estimated risk of receiving the interventions for each of five ordered deprivation groups using a time-to-event approach with Cox regression frailty models. Interventions in primary and secondary prevention included risk-factor measurement, smoking management, statins and antihypertensive therapy, and in established CHD included medication and revascularization. For primary prevention, five of the 11 models favoured the more deprived and one favoured the less deprived. For medication in secondary prevention and established CHD, one of the 15 models favoured the more deprived and one the less deprived. In relation to revascularization, six of the 12 models favoured the less deprived and none favoured the more deprived–this evidence of inequity exemplified by a hazard ratio for revascularization in stable angina of 0.79 (95% confidence interval 0.68, 0.92). The main study limitation is the possibility of under-ascertainment or misclassification of clinical indications and treatment from variability in coding. Primary care components of CHD healthcare were equitably delivered. Evidence of inequity was found for revascularization procedures, although this inequity is likely to have only a modest effect on social gradients in CHD mortality. Policymakers should focus on reducing inequalities in CHD risk factors, particularly smoking, as these, rather than inequity in healthcare, are likely to be key drivers of inequalities in CHD mortality

Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature

There is a general understanding that socioeconomically disadvantaged people are also disadvantaged with respect to their access to NHS care. Insofar as considerable NHS funding has been targeted at deprived areas, it is important to better understand whether and why socioeconomic variations in access and utilisation exist. Exploring this question with reference to cardiovascular care, our aims were to synthesise and evaluate evidence relating to access to and/or use of English NHS services around (i) different points on the care pathway (i.e. presentation, primary management and specialist management) and (ii) different dimensions of inequality (socioeconomic, age- and gender-related, ethnic or geographical). Restricting our search period from 2004 to 2016, we were concerned to examine whether, compared to earlier research, there has been a change in the focus of research examining inequalities in cardiac care and whether the pro-rich bias reported in the late 1990s and early 2000s still applies today. We conducted a scoping study drawing on Arksey &amp; O'Malley's framework. A total of 174 studies were included in the review and appraised for methodological quality. Although, in the past decade, there has been a shift in research focus away from gender and age inequalities in access/use and towards socioeconomic status and ethnicity, evidence that deprived people are less likely to access and use cardiovascular care is very contradictory. Patterns of use appear to vary by ethnicity; South Asian populations enjoying higher access, black populations lower. By contrast, female gender and older age are consistently associated with inequity in cardiovascular care. The degree of geographical variation in access/use is also striking. Finally, evidence of inequality increases with stage on the care pathway, which may indicate that barriers to access arise from the way in which health professionals are adjudicating health needs rather than a failure to seek help in the first place.</p

Survey of people with diabetes in South Humberside

SIGLEAvailable from British Library Document Supply Centre-DSC:q97/00241 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Ischaemic heart disease: poor man's disease in rich man's society Health Care Needs Assessment Project final report - morbidity analysis phase 2 general practice data

SIGLEAvailable from British Library Document Supply Centre-DSC:q96/09665 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Re-engaging with the physical environment: a health-related environmental classification of the UK

This paper presents a health-related area-level multiple environmental classification of the UK and examines ecological associations with health. This classification, akin to a geodemographic profile of the environment, classifies small areas across the UK into seven environment types ranging from 'Industrial' to 'Sunny, clean and green'. The data for the classification were gathered from a range of agencies, rendered to Census Area Statistic Wards (n = 10 654) and processed through a two-stage clustering technique to create a Multiple Environmental Deprivation Classification, or MEDClass. In order to explore the utility of MEDClass, this paper presents an empirical investigation into the extent to which the type of physical environment one lives in can influence self-reported health and mortality rates. The findings suggest that while physical environment 'type' makes a modest contribution towards our understanding of health inequalities, socio-economic deprivation remains the most important challenge for those seeking to address these inequalities. In conclusion we suggest that human geographers should embrace a broader conceptualisation of the environment and in particular, re-engage with traditional aspects of the physical environment