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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: Coronary revascularisation
124 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 7920 | OXMIS | Saphenous vein graft replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7920000 | OXMIS | Saphenous vein graft replacement of one coronary artery | surgery | res15: Coronary revascularisation | |||
| 7920100 | OXMIS | Saphenous vein graft replacement of two coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7920.11 | OXMIS | Saphenous vein graft bypass of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7920200 | OXMIS | Saphenous vein graft replacement of three coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7920300 | OXMIS | Saphenous vein graft replacement of four+ coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7921 | OXMIS | Other autograft replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7921000 | OXMIS | Autograft replacement of one coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 7921100 | OXMIS | Autograft replacement of two coronary arteries NEC | surgery | res15: Coronary revascularisation | |||
| 7921.11 | OXMIS | Other autograft bypass of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7921200 | OXMIS | Autograft replacement of three coronary arteries NEC | surgery | res15: Coronary revascularisation | |||
| 7921300 | OXMIS | Autograft replacement of four of more coronary arteries NEC | surgery | res15: Coronary revascularisation | |||
| 7922 | OXMIS | Allograft replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7922000 | OXMIS | Allograft replacement of one coronary artery | surgery | res15: Coronary revascularisation | |||
| 7922100 | OXMIS | Allograft replacement of two coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7922.11 | OXMIS | Allograft bypass of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7922200 | OXMIS | Allograft replacement of three coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7922300 | OXMIS | Allograft replacement of four or more coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7923 | OXMIS | Prosthetic replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7923000 | OXMIS | Prosthetic replacement of one coronary artery | surgery | res15: Coronary revascularisation | |||
| 7923100 | OXMIS | Prosthetic replacement of two coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7923.11 | OXMIS | Prosthetic bypass of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7923200 | OXMIS | Prosthetic replacement of three coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7923300 | OXMIS | Prosthetic replacement of four or more coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7924 | OXMIS | Revision of bypass for coronary artery | surgery | res15: Coronary revascularisation | |||
| 7924000 | OXMIS | Revision of bypass for one coronary artery | surgery | res15: Coronary revascularisation | |||
| 7924100 | OXMIS | Revision of bypass for two coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7924200 | OXMIS | Revision of bypass for three coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7924300 | OXMIS | Revision of bypass for four or more coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7924400 | OXMIS | Revision of connection of thoracic artery to coronary artery | surgery | res15: Coronary revascularisation | |||
| 7924500 | OXMIS | Revision of implantation of thoracic artery into heart | surgery | res15: Coronary revascularisation | |||
| 7925 | OXMIS | Connection of mammary artery to coronary artery | surgery | res15: Coronary revascularisation | |||
| 7925000 | OXMIS | Double anastomosis of mammary arteries to coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7925011 | OXMIS | LIMA sequential anastomosis | surgery | res15: Coronary revascularisation | |||
| 7925012 | OXMIS | RIMA sequential anastomosis | surgery | res15: Coronary revascularisation | |||
| 7925100 | OXMIS | Double implant of mammary arteries into coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7925.11 | OXMIS | Creation of bypass from mammary artery to coronary artery | surgery | res15: Coronary revascularisation | |||
| 7925200 | OXMIS | Single anast mammary art to left ant descend coronary art | surgery | res15: Coronary revascularisation | |||
| 7925300 | OXMIS | Single anastomosis of mammary artery to coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 7925311 | OXMIS | LIMA single anastomosis | surgery | res15: Coronary revascularisation | |||
| 7925312 | OXMIS | RIMA single anastomosis | surgery | res15: Coronary revascularisation | |||
| 7925400 | OXMIS | Single implantation of mammary artery into coronary artery | surgery | res15: Coronary revascularisation | |||
| 7926 | OXMIS | Connection of other thoracic artery to coronary artery | surgery | res15: Coronary revascularisation | |||
| 7926000 | OXMIS | Double anastom thoracic arteries to coronary arteries NEC | surgery | res15: Coronary revascularisation | |||
| 7926100 | OXMIS | Double implant thoracic arteries into coronary arteries NEC | surgery | res15: Coronary revascularisation | |||
| 7926200 | OXMIS | Single anastomosis of thoracic artery to coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 7926300 | OXMIS | Single implantation thoracic artery into coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 7927 | OXMIS | Other open operations on coronary artery | surgery | res15: Coronary revascularisation | |||
| 7927300 | OXMIS | Transposition of coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 7927400 | OXMIS | Exploration of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7927500 | OXMIS | Open angioplasty of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7928 | OXMIS | Transluminal balloon angioplasty of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7928000 | OXMIS | Percut transluminal balloon angioplasty one coronary artery | surgery | res15: Coronary revascularisation | |||
| 7928100 | OXMIS | Percut translum balloon angioplasty mult coronary arteries | surgery | res15: Coronary revascularisation | |||
| 7928.11 | OXMIS | Percutaneous balloon coronary angioplasty | surgery | res15: Coronary revascularisation | |||
| 7928200 | OXMIS | Percut translum balloon angioplasty bypass graft coronary a | surgery | res15: Coronary revascularisation | |||
| 7928300 | OXMIS | Percut translum cutting balloon angioplasty coronary artery | surgery | res15: Coronary revascularisation | |||
| 7929 | OXMIS | Other therapeutic transluminal operations on coronary artery | surgery | res15: Coronary revascularisation | |||
| 7929000 | OXMIS | Percutaneous transluminal laser coronary angioplasty | surgery | res15: Coronary revascularisation | |||
| 7929100 | OXMIS | Percut transluminal coronary thrombolysis with streptokinase | surgery | res15: Coronary revascularisation | |||
| 7929111 | OXMIS | Percut translum coronary thrombolytic therapy- streptokinase | surgery | res15: Coronary revascularisation | |||
| 7929200 | OXMIS | Percut translum inject therap subst to coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 7929300 | OXMIS | Rotary blade coronary angioplasty | surgery | res15: Coronary revascularisation | |||
| 7929400 | OXMIS | Insertion of coronary artery stent | surgery | res15: Coronary revascularisation | |||
| 7929500 | OXMIS | Insertion of drug-eluting coronary artery stent | surgery | res15: Coronary revascularisation | |||
| 7929600 | OXMIS | Percutaneous transluminal atherectomy of coronary artery | surgery | res15: Coronary revascularisation | |||
| 792..00 | Read/OXMIS | Coronary artery operations | surgery | res15: Coronary revascularisation | |||
| 7920y00 | Read/OXMIS | Saphenous vein graft replacement of coronary artery OS | surgery | res15: Coronary revascularisation | |||
| 7920z00 | Read/OXMIS | Saphenous vein graft replacement coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 792..11 | Read/OXMIS | Coronary artery bypass graft operations | surgery | res15: Coronary revascularisation | |||
| 7921y00 | Read/OXMIS | Other autograft replacement of coronary artery OS | surgery | res15: Coronary revascularisation | |||
| 7921z00 | Read/OXMIS | Other autograft replacement of coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7922y00 | Read/OXMIS | Other specified allograft replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7922z00 | Read/OXMIS | Allograft replacement of coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7923y00 | Read/OXMIS | Other specified prosthetic replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 7923z00 | Read/OXMIS | Prosthetic replacement of coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7924y00 | Read/OXMIS | Other specified revision of bypass for coronary artery | surgery | res15: Coronary revascularisation | |||
| 7924z00 | Read/OXMIS | Revision of bypass for coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7925y00 | Read/OXMIS | Connection of mammary artery to coronary artery OS | surgery | res15: Coronary revascularisation | |||
| 7925z00 | Read/OXMIS | Connection of mammary artery to coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7926y00 | Read/OXMIS | Connection of other thoracic artery to coronary artery OS | surgery | res15: Coronary revascularisation | |||
| 7926z00 | Read/OXMIS | Connection of other thoracic artery to coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7927y00 | Read/OXMIS | Other specified other open operation on coronary artery | surgery | res15: Coronary revascularisation | |||
| 7927z00 | Read/OXMIS | Other open operation on coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7928y00 | Read/OXMIS | Transluminal balloon angioplasty of coronary artery OS | surgery | res15: Coronary revascularisation | |||
| 7928z00 | Read/OXMIS | Transluminal balloon angioplasty of coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 7929y00 | Read/OXMIS | Other therapeutic transluminal op on coronary artery OS | surgery | res15: Coronary revascularisation | |||
| 7929z00 | Read/OXMIS | Other therapeutic transluminal op on coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 792A.00 | Read/OXMIS | Diagnostic transluminal operations on coronary artery | surgery | res15: Coronary revascularisation | |||
| 792Ay00 | Read/OXMIS | Diagnostic transluminal operation on coronary artery OS | surgery | res15: Coronary revascularisation | |||
| 792Az00 | Read/OXMIS | Diagnostic transluminal operation on coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 792B.00 | Read/OXMIS | Repair of coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 792B000 | Read/OXMIS | Endarterectomy of coronary artery NEC | surgery | res15: Coronary revascularisation | |||
| 792By00 | Read/OXMIS | Other specified repair of coronary artery | surgery | res15: Coronary revascularisation | |||
| 792Bz00 | Read/OXMIS | Repair of coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 792C.00 | Read/OXMIS | Other replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 792C000 | Read/OXMIS | Replacement of coronary arteries using multiple methods | surgery | res15: Coronary revascularisation | |||
| 792Cy00 | Read/OXMIS | Other specified replacement of coronary artery | surgery | res15: Coronary revascularisation | |||
| 792Cz00 | Read/OXMIS | Replacement of coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 792D.00 | Read/OXMIS | Other bypass of coronary artery | surgery | res15: Coronary revascularisation | |||
| 792Dy00 | Read/OXMIS | Other specified other bypass of coronary artery | surgery | res15: Coronary revascularisation | |||
| 792Dz00 | Read/OXMIS | Other bypass of coronary artery NOS | surgery | res15: Coronary revascularisation | |||
| 792y.00 | Read/OXMIS | Other specified operations on coronary artery | surgery | res15: Coronary revascularisation | |||
| 792z.00 | Read/OXMIS | Coronary artery operations NOS | surgery | res15: Coronary revascularisation | |||
| 793G.00 | Read/OXMIS | Perc translumin balloon angioplasty stenting coronary artery | surgery | res15: Coronary revascularisation | |||
| 793G000 | Read/OXMIS | Perc translum ball angio insert 1-2 drug elut stents cor art | surgery | res15: Coronary revascularisation | |||
| 793G100 | Read/OXMIS | Perc tran ball angio ins 3 or more drug elut stents cor art | surgery | res15: Coronary revascularisation | |||
| 793G200 | Read/OXMIS | Perc translum balloon angioplasty insert 1-2 stents cor art | surgery | res15: Coronary revascularisation | |||
| 793G300 | Read/OXMIS | Percutaneous cor balloon angiop 3 more stents cor art NEC | surgery | res15: Coronary revascularisation | |||
| 793Gz00 | Read/OXMIS | Perc translum balloon angioplasty stenting coronary art NOS | surgery | res15: Coronary revascularisation | |||
| 793H000 | Read/OXMIS | Percutaneous transluminal balloon dilation cardiac conduit | surgery | res15: Coronary revascularisation | |||
| 7A54500 | Read/OXMIS | Rotary blade angioplasty | surgery | res15: Coronary revascularisation | |||
| 7A6G100 | Read/OXMIS | Peroperative angioplasty | surgery | res15: Coronary revascularisation | |||
| 7A6H300 | Read/OXMIS | Prosthetic graft patch angioplasty | surgery | res15: Coronary revascularisation | |||
| 7A6H400 | Read/OXMIS | Percutaneous transluminal angioplasty of vascular graft | surgery | res15: Coronary revascularisation | |||
| K3043 | Read/OXMIS | Bypass graft aortocoronary | surgery | res15: Coronary revascularisation | |||
| K3043C | Read/OXMIS | Coronary artery bypass | surgery | res15: Coronary revascularisation | |||
| K3043T | Read/OXMIS | Coronary artery bypass grafts triple | surgery | res15: Coronary revascularisation | |||
| K306 A | Read/OXMIS | Coronary angioplasty | surgery | res15: Coronary revascularisation | |||
| ZV45700 | Read/OXMIS | [V]Presence of aortocoronary bypass graft | surgery | res15: Coronary revascularisation | |||
| ZV45800 | Read/OXMIS | [V]Presence of coronary angioplasty implant and graft | surgery | res15: Coronary revascularisation | |||
| ZV45K00 | Read/OXMIS | [V]Presence of coronary artery bypass graft | surgery | res15: Coronary revascularisation | |||
| ZV45K11 | Read/OXMIS | [V]Presence of coronary artery bypass graft - CABG | surgery | res15: Coronary revascularisation | |||
| ZV45L00 | Read/OXMIS | [V]Status following coronary angioplasty NOS | surgery | res15: Coronary revascularisation |
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