Heart 1999;81:252-256 ( March )

Geographic, demographic, and socioeconomic variations in the investigation and management of coronary heart disease in Scotland

M C M MacLeod,^a A R Finlayson,^a J P Pell,^b I N Findlay^c

^a Information and Statistics Division, Scottish Health Service, Edinburgh, UK, ^b Greater Glasgow Health Board, Glasgow, UK, ^c Royal Alexandra Hospital, Paisley, UK

Correspondence to: Dr I Findlay, Royal Alexandra Hospital, Corsebar Road, Paisley, Renfrewshire PA2 9PN, UK

Accepted for publication 9 October 1998

OBJECTIVETo determine whether age, sex, level of deprivation, and area of residence affect the likelihood of investigation and treatment of patients with coronary heart disease.
DESIGN, PATIENTS, AND INTERVENTIONSRoutine discharge data were used to identify patients admitted with acute myocardial infarction (AMI) between 1991 and 1993 inclusive. Record linkage provided the proportion undergoing angiography, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG) over the following two years. Multiple logistic regression analysis was used to determine whether age, sex, deprivation, and area of residence were independently associated with progression to investigation and revascularisation.
SETTINGMainland Scotland 1991 to 1995 inclusive.
MAIN OUTCOME MEASURESTwo year incidence of angiography, PTCA, and CABG.
Results36 838 patients were admitted with AMI. 4831 (13%) underwent angiography, 587 (2%) PTCA, and 1825 (5%) CABG. Women were significantly less likely to undergo angiography (p < 0.001) and CABG (p < 0.001) but more likely to undergo PTCA (p < 0.05). Older patients were less likely to undergo all three procedures (p < 0.001). Socioeconomic deprivation was associated with a reduced likelihood of both angiography and CABG (p < 0.001). There were significant geographic variations in all three modalities (p < 0.001).
CONCLUSIONVariations in investigation and management were demonstrated by age, sex, geography, and socioeconomic deprivation. These are unlikely to be accounted for by differences in need; differences in clinical practice are, therefore, likely.

Keywords: geographic variations; socioeconomic deprivation; coronary revascularisation; ischaemic heart disease; epidemiology

---

© 1999 by Heart
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• McComb, J. M., Plummer, C. J., Cunningham, M. W., Cunningham, D. (2009). Inequity of access to implantable cardioverter defibrillator therapy in England: possible causes of geographical variation in implantation rates. Europace 11: 1308-1312 [Abstract] [Full Text]  
• Petty, D. R., Silcock, J. (2008). Explanations for variations in clopidogrel prescribing in England. J Public Health (Oxf) 30: 494-498 [Abstract] [Full Text]  
• Sekhri, N., Timmis, A., Chen, R., Junghans, C., Walsh, N., Zaman, J., Eldridge, S., Hemingway, H., Feder, G. (2008). Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris. BMJ 336: 1058-1061 [Abstract] [Full Text]  
• Mindell, J., Klodawski, E., Fitzpatrick, J. (2008). Using routine data to measure ethnic differentials in access to coronary revascularization. J Public Health (Oxf) 30: 45-53 [Abstract] [Full Text]  
• McGovern, M. P, Boroujerdi, M. A, Taylor, M. W, Williams, D. J, Hannaford, P. C, Lefevre, K. E, Simpson, C. R (2008). The effect of the UK incentive-based contract on the management of patients with coronary heart disease in primary care. Fam Pract 25: 33-39 [Abstract] [Full Text]  
• Denvir, M A, Lee, A J, Rysdale, J, Walker, A, Eteiba, H, Starkey, I R, Pell, J P (2006). Influence of socioeconomic status on clinical outcomes and quality of life after percutaneous coronary intervention.. J. Epidemiol. Community Health 60: 1085-1088 [Abstract] [Full Text]  
• Hetemaa, T., Manderbacka, K., Reunanen, A., Koskinen, S., Keskimaki, I. (2006). Socioeconomic inequities in invasive cardiac procedures among patients with incident angina pectoris or myocardial infarction. Scand J Public Health 34: 116-123 [Abstract]  
• Strong, M., Maheswaran, R., Radford, J. (2006). Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework. J Public Health (Oxf) 28: 39-42 [Abstract] [Full Text]  
• Picciotto, S., Forastiere, F., Stafoggia, M., D'Ippoliti, D., Ancona, C., Perucci, C. A (2006). Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy. J. Epidemiol. Community Health 60: 37-43 [Abstract] [Full Text]  
• Clark, A M, Findlay, I N, for the Have a Heart Paisley IT Group, (2005). Improving evidence based cardiac care and policy implementation over the patient journey: the potential of coronary heart disease registers. Heart 91: 1127-1130 [Abstract] [Full Text]  
• Metcalfe, C., Davey Smith, G., Sterne, J. A. C., Heslop, P., Macleod, J., Hart, C. L. (2005). Cause-specific hospital admission and mortality among working men: association with socioeconomic circumstances in childhood and adult life, and the mediating role of daily stress. Eur J Public Health 15: 238-244 [Abstract] [Full Text]  
• Morris, R W, Whincup, P H, Papacosta, O, Walker, M, Thomson, A (2005). Inequalities in coronary revascularisation during the 1990s: evidence from the British regional heart study. Heart 91: 635-640 [Abstract] [Full Text]  
• McKevitt, C., Coshall, C., Tilling, K., Wolfe, C. (2005). Are There Inequalities in the Provision of Stroke Care?: Analysis of an Inner-City Stroke Register. Stroke 36: 315-320 [Abstract] [Full Text]  
• Macleod, M R, Smith, S J (2005). Gender and deprivation and rates of referral and thereby admission to a national neurorehabilitation service. Clin Rehabil 19: 109-115 [Abstract]  
• Britton, A., Shipley, M., Marmot, M., Hemingway, H. (2004). Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study. BMJ 329: 318- [Abstract] [Full Text]  
• McAlister, F A, Murphy, N F, Simpson, C R, Stewart, S, MacIntyre, K, Kirkpatrick, M, Chalmers, J, Redpath, A, Capewell, S, McMurray, J J V (2004). Influence of socioeconomic deprivation on the primary care burden and treatment of patients with a diagnosis of heart failure in general practice in Scotland: population based study. BMJ 328: 1110- [Abstract] [Full Text]  
• Ward, P R, Noyce, P R, St Leger, A S (2004). Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England. J. Epidemiol. Community Health 58: 89-96 [Abstract] [Full Text]  
• Taylor, F C, Ascione, R, Rees, K, Narayan, P, Angelini, G D (2003). Socioeconomic deprivation is a predictor of poor postoperative cardiovascular outcomes in patients undergoing coronary artery bypass grafting. Heart 89: 1062-1066 [Abstract] [Full Text]  
• Hetemaa, T, Keskimaki, I, Manderbacka, K, Leyland, A H, Koskinen, S (2003). How did the recent increase in the supply of coronary operations in Finland affect socioeconomic and gender equity in their use?. J. Epidemiol. Community Health 57: 178-185 [Abstract] [Full Text]  
• Pears, E, Hannaford, P., Taylor, M. (2003). Gender, age and deprivation differences in the primary care management of hypertension in Scotland: a cross-sectional database study. Fam Pract 20: 22-31 [Abstract] [Full Text]  
• Pell, J P, Denvir, M A (2002). Angioplasty, bypass surgery or medical treatment: how should we decide?. Heart 88: 451-452 [Abstract] [Full Text]  
• Richards, H. M., Reid, M. E., Watt, G. C. M. (2002). Socioeconomic variations in responses to chest pain: qualitative study. BMJ 324: 1308-1308 [Abstract] [Full Text]  
• Feder, G., Crook, A. M, Magee, P., Banerjee, S., Timmis, A. D, Hemingway, H. (2002). Ethnic differences in invasive management of coronary disease: prospective cohort study of patients undergoing angiography. BMJ 324: 511-516 [Abstract] [Full Text]  
• Richards, H., McConnachie, A., Morrison, C., Murray, K., Watt, G. (2000). Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain. J. Epidemiol. Community Health 54: 714-718 [Abstract] [Full Text]  
• Pell, J. P, Pell, A. C H, Norrie, J., Ford, I., Cobbe, S. M, Hart, J. T. (2000). Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study • Commentary: Three decades of the inverse care law. BMJ 320: 15-19 [Abstract] [Full Text]