ArticleBMJ (Clinical research ed.)2004
Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study.
Article in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00005680 (Whitehall II - Social and Occupational Influences On Health and Illness), which is not on this map. Cited by 30 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Whitehall II - Social and Occupational Influences On Health and Illness
Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 100 citations in OpenAlex.
- South Asians and coronary disease: is there discordance between effects on incidence and prognosis?Heart (British Cardiac Society) · 2013Pooled it
- Trial
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- The Association of Unfairness with Mental and Physical Health in a Multiethnic Sample of Adults: Cross-sectional Study.JMIR public health and surveillance · 2021Article
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- Use of exercise tests in primary care: importance for referral decisions and possible bias in the decision process; a prospective observational study.BMC family practice · 2014Observational
- Myocardial infarction incidence and survival by ethnic group: Scottish Health and Ethnicity Linkage retrospective cohort study.BMJ open · 2013Article
- Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma.International journal of public health · 2013Article
- Effect of ethnicity on the prevalence, severity, and management of COPD in general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2012Article
- Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients.BMC cardiovascular disorders · 2011Article
- Diffusion of new medication across different income groups under a universal health insurance program: an example involving newly enlisted nonsteroidal anti-inflammatory drugs for elderly osteoarthritis patients.International journal of public health · 2010Article
- Article
- Outcomes in a diabetic population of South Asians and whites following hospitalization for acute myocardial infarction: a retrospective cohort study.Cardiovascular diabetology · 2010Article
- Universal health care no guarantee of equity: comparison of socioeconomic inequalities in the receipt of coronary procedures in patients with acute myocardial infarction and angina.BMC public health · 2009Article
- Preventing premature mortality in chronic diseases for South Asians in the UK and beyond.Journal of the Royal Society of Medicine · 2009Article
- Ethnic disparities in coronary heart disease management and pay for performance in the UK.Journal of general internal medicine · 2009Article
- Practice characteristics and prescribing of cardiovascular drugs in areas with higher risk of CHD in Scotland: cross-sectional study.International journal for equity in health · 2008Article
- Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris.BMJ (Clinical research ed.) · 2008Article
- Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups.Heart (British Cardiac Society) · 2008Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo determine whether access to cardiac procedures and drugs contributes to social and ethnic differences in coronary heart disease in a population setting.
designProspective study with follow up over 15 years. Civil service employment grade was used as a measure of individual socioeconomic position. Need for cardiac care was determined by the presence of angina, myocardial infarction, and coronary risk factors.
setting20 civil service departments originally located in London.
participants10,308 civil servants (3414 women; 560 South Asian) aged 35-55 years at baseline in 1985-8.
main outcome measuresUse of exercise electrocardiography, coronary angiography, and coronary revascularisation procedures and secondary prevention drugs.
resultsInverse social gradients existed in incident coronary morbidity and mortality. South Asian participants also had higher rates than white participants. After adjustment for clinical need, social position showed no association with the use of cardiac procedures or secondary prevention drugs. For example, men in the low versus high employment grade had an age adjusted odds ratio for angiography of 1.87 (95% confidence interval 1.32 to 2.64), which decreased to 1.27 (0.83 to 1.94) on adjustment for clinical need. South Asians tended to be more likely to have cardiac procedures and to be taking more secondary prevention drugs than white participants, even after adjustment for clinical need.
conclusionThis population based study, which shows the widely observed social and ethnic patterning of coronary heart disease, found no evidence that low social position or South Asian ethnicity was associated with lower use of cardiac procedures or drugs, independently of clinical need. Differences in medical care are unlikely to contribute to social or ethnic differences in coronary heart disease in this cohort.
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