The UK National Health Service: delivering equitable treatment across the spectrum of coronary disease. Hawkins, N. M., Scholes, S., Bajekal, M., Love, H., O'Flaherty, M., Raine, R., & Capewell, S. Circulation. Cardiovascular Quality and Outcomes, 6(2):208--216, March, 2013. doi abstract bibtex BACKGROUND: Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity, or treatment. It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina. METHODS AND RESULTS: This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30% to \textgreater60%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina. CONCLUSIONS: Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.
@article{hawkins_uk_2013,
title = {The {UK} {National} {Health} {Service}: delivering equitable treatment across the spectrum of coronary disease},
volume = {6},
issn = {1941-7705},
shorttitle = {The {UK} {National} {Health} {Service}},
doi = {10.1161/CIRCOUTCOMES.111.000058},
abstract = {BACKGROUND: Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity, or treatment. It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina.
METHODS AND RESULTS: This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30\% to {\textgreater}60\%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina.
CONCLUSIONS: Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.},
language = {eng},
number = {2},
journal = {Circulation. Cardiovascular Quality and Outcomes},
author = {Hawkins, Nathaniel M. and Scholes, Shaun and Bajekal, Madhavi and Love, Hande and O'Flaherty, Martin and Raine, Rosalind and Capewell, Simon},
month = mar,
year = {2013},
pmid = {23481523},
keywords = {Adrenergic beta-Antagonists, Age Factors, Aged, Angina Pectoris, Angiotensin II Type 1 Receptor Blockers, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular Agents, Coronary Disease, Cross-Sectional Studies, Delivery of Health Care, Female, Great Britain, Health Care Surveys, Healthcare Disparities, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Myocardial Infarction, Outcome and Process Assessment (Health Care), Physician's Practice Patterns, Platelet Aggregation Inhibitors, Primary Health Care, Secondary Care, Secondary Prevention, Sex Factors, Socioeconomic Factors, State Medicine, Treatment Outcome},
pages = {208--216}
}
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It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina. METHODS AND RESULTS: This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30% to \\textgreater60%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina. CONCLUSIONS: Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.","language":"eng","number":"2","journal":"Circulation. Cardiovascular Quality and Outcomes","author":[{"propositions":[],"lastnames":["Hawkins"],"firstnames":["Nathaniel","M."],"suffixes":[]},{"propositions":[],"lastnames":["Scholes"],"firstnames":["Shaun"],"suffixes":[]},{"propositions":[],"lastnames":["Bajekal"],"firstnames":["Madhavi"],"suffixes":[]},{"propositions":[],"lastnames":["Love"],"firstnames":["Hande"],"suffixes":[]},{"propositions":[],"lastnames":["O'Flaherty"],"firstnames":["Martin"],"suffixes":[]},{"propositions":[],"lastnames":["Raine"],"firstnames":["Rosalind"],"suffixes":[]},{"propositions":[],"lastnames":["Capewell"],"firstnames":["Simon"],"suffixes":[]}],"month":"March","year":"2013","pmid":"23481523","keywords":"Adrenergic beta-Antagonists, Age Factors, Aged, Angina Pectoris, Angiotensin II Type 1 Receptor Blockers, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular Agents, Coronary Disease, Cross-Sectional Studies, Delivery of Health Care, Female, Great Britain, Health Care Surveys, Healthcare Disparities, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Myocardial Infarction, Outcome and Process Assessment (Health Care), Physician's Practice Patterns, Platelet Aggregation Inhibitors, Primary Health Care, Secondary Care, Secondary Prevention, Sex Factors, Socioeconomic Factors, State Medicine, Treatment Outcome","pages":"208--216","bibtex":"@article{hawkins_uk_2013,\n\ttitle = {The {UK} {National} {Health} {Service}: delivering equitable treatment across the spectrum of coronary disease},\n\tvolume = {6},\n\tissn = {1941-7705},\n\tshorttitle = {The {UK} {National} {Health} {Service}},\n\tdoi = {10.1161/CIRCOUTCOMES.111.000058},\n\tabstract = {BACKGROUND: Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity, or treatment. It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina.\nMETHODS AND RESULTS: This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30\\% to {\\textgreater}60\\%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina.\nCONCLUSIONS: Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Circulation. 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