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Research article:
The UK National Health Service: Delivering Equitable Treatment Across the Spectrum of Coronary Disease
Reference:
Nathaniel M. Hawkins, Shaun Scholes, Madhavi Bajekal, Hande Love, Martin O’Flaherty, Rosalind Raine, Simon Capewell(2013) The UK National Health Service: Delivering Equitable Treatment Across the Spectrum of Coronary Disease. Circulation: Cardiovascular Quality and Outcomes, doi: 10.1161/CIRCOUTCOMES.111.000058
- Link to fulltext article
- 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 >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.
- Author for correspondence
- Nathaniel M. Hawkins
- Email for correspondence
- nathawkins@hotmail.com
Code list: res15: Angina
52 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 14A5.00 | Read | H/O: angina pectoris | diagnostic | res15: Angina | |||
| 14AJ.00 | Read | H/O: Angina in last year | diagnostic | res15: Angina | |||
| G311.00 | Read | Preinfarction syndrome | diagnostic | res15: Angina | |||
| G311100 | Read | Unstable angina | diagnostic | res15: Angina | |||
| G311.11 | Read | Crescendo angina | diagnostic | res15: Angina | |||
| G311.12 | Read | Impending infarction | diagnostic | res15: Angina | |||
| G311.13 | Read | Unstable angina | diagnostic | res15: Angina | |||
| G311.14 | Read | Angina at rest | diagnostic | res15: Angina | |||
| G311200 | Read | Angina at rest | diagnostic | res15: Angina | |||
| G311300 | Read | Refractory angina | diagnostic | res15: Angina | |||
| G311400 | Read | Worsening angina | diagnostic | res15: Angina | |||
| G311500 | Read | Acute coronary syndrome | diagnostic | res15: Angina | |||
| G311z00 | Read | Preinfarction syndrome NOS | diagnostic | res15: Angina | |||
| G312.00 | Read | Coronary thrombosis not resulting in MI | diagnostic | res15: Angina | |||
| G31y000 | Read | Acute coronary insufficiency | diagnostic | res15: Angina | |||
| G31y200 | Read | Subendocardial ischaemia | diagnostic | res15: Angina | |||
| G31y300 | Read | Transient myocardial ischaemia | diagnostic | res15: Angina | |||
| G33..00 | Read | Angina pectoris | diagnostic | res15: Angina | |||
| G330.00 | Read | Angina decubitus | diagnostic | res15: Angina | |||
| G330000 | Read | Nocturnal angina | diagnostic | res15: Angina | |||
| G330z00 | Read | Angina decubitus NOS | diagnostic | res15: Angina | |||
| G331.00 | Read | Prinzmetal's angina | diagnostic | res15: Angina | |||
| G331.11 | Read | Variant angina pectoris | diagnostic | res15: Angina | |||
| g332.00 | Read | Coronary artery spasm | diagnostic | res15: Angina | |||
| G332.00 | Read | Coronary artery spasm | diagnostic | res15: Angina | |||
| G33z.00 | Read | Angina pectoris NOS | diagnostic | res15: Angina | |||
| G33z000 | Read | Status anginosus | diagnostic | res15: Angina | |||
| G33z100 | Read | Stenocardia | diagnostic | res15: Angina | |||
| G33z200 | Read | Syncope anginosa | diagnostic | res15: Angina | |||
| G33z300 | Read | Angina on effort | diagnostic | res15: Angina | |||
| G33z600 | Read | New onset angina | diagnostic | res15: Angina | |||
| G33z700 | Read | Stable angina | diagnostic | res15: Angina | |||
| G33zz00 | Read | Angina pectoris NOS | diagnostic | res15: Angina | |||
| G34y000 | Read | Chronic coronary insufficiency | diagnostic | res15: Angina | |||
| G34y100 | Read | Chronic myocardial ischaemia | diagnostic | res15: Angina | |||
| Gyu3000 | Read | [X]Other forms of angina pectoris | diagnostic | res15: Angina | |||
| 4119P | OXMIS | Syndrome preinfarction myocardia | diagnostic | res15: Angina | |||
| 4129RE | OXMIS | Sclerosis endocardial | diagnostic | res15: Angina | |||
| 4130 | OXMIS | Angina pectoris with hypertension | diagnostic | res15: Angina | |||
| 4130E | OXMIS | Angina effort with hypertension | diagnostic | res15: Angina | |||
| 4139 | OXMIS | Angina pectoris | diagnostic | res15: Angina | |||
| 4139AA | OXMIS | Angina attack | diagnostic | res15: Angina | |||
| 4139AT | OXMIS | Angina atypical | diagnostic | res15: Angina | |||
| 4139C | OXMIS | Cardiac angina | diagnostic | res15: Angina | |||
| 4139CO | OXMIS | Angina crescendo | diagnostic | res15: Angina | |||
| 4139E | OXMIS | Angina effort | diagnostic | res15: Angina | |||
| 4139M | OXMIS | Syndrome anginal | diagnostic | res15: Angina | |||
| 4139N | OXMIS | Angina | diagnostic | res15: Angina | |||
| 4139PA | OXMIS | Angina inversa | diagnostic | res15: Angina | |||
| 4139PB | OXMIS | Prinzmetal's angina | diagnostic | res15: Angina | |||
| 4139PC | OXMIS | Variant angina pectoris | diagnostic | res15: Angina | |||
| 4139U | OXMIS | Unstable angina | diagnostic | res15: Angina |
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