ArticleBMC cardiovascular disorders2011
Variations in cardiovascular disease under-diagnosis in England: national cross-sectional spatial analysis.
Article in BMC cardiovascular disorders, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- Pooled it
- Unveiling the hidden burden: estimating the proportion of undiagnosed depression, hypertension and diabetes - a modelling study using survey data from adults in England, 2011-2019.BMJ public health · 2025Article
- Estimating the burden of underdiagnosis within England: A modelling study of linked primary care data.PloS one · 2025Article
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- Co-circulation and misdiagnosis led to underestimation of the 2015-2017 Zika epidemic in the Americas.PLoS neglected tropical diseases · 2021Article
- Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study.Journal of Alzheimer's disease : JAD · 2020Article
- Examining the Effect of the Environment and Commuting Flow from/to Epidemic Areas on the Spread of Dengue Fever.International journal of environmental research and public health · 2019Article
- Exploring spatial patterns of cardiovascular disease in Sweden between 2000 and 2010.Scandinavian journal of public health · 2018Article
- Clinical Outcomes of Single-Level Anterior Cervical Discectomy and Fusion.International journal of spine surgery · 2018Article
- Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis.BMC medicine · 2018Article
- Disenrollment from general practitioners among chronic patients: a register-based longitudinal study of Norwegian claims data.BMC family practice · 2016Article
- The spatial structure of chronic morbidity: evidence from UK census returns.International journal of health geographics · 2016Article
- Analysis of the spatial variation of hospitalization admissions for hypertension disease in Shenzhen, China.International journal of environmental research and public health · 2014Article
- Modelling factors in primary care quality improvement: a cross-sectional study of premature CHD mortality.BMJ open · 2013Article
- Uptake of atrial fibrillation screening aiming at stroke prevention: geo-mapping of target population and non-participation.BMC public health · 2013Article
- Geographic variation in susceptibility to ventilator-associated pneumonia after traumatic injury.The journal of trauma and acute care surgery · 2013Article
- Are there enough GPs in England to detect hypertension and maintain access? A cross-sectional study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2013Article
- Regional disparities in mortality after ischemic heart disease in a Brazilian state from 2006 to 2010.PloS one · 2013Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThere is under-diagnosis of cardiovascular disease (CVD) in the English population, despite financial incentives to encourage general practices to register new cases. We compared the modelled (expected) and diagnosed (observed) prevalence of three cardiovascular conditions- coronary heart disease (CHD), hypertension and stroke- at local level, their geographical variation, and population and healthcare predictors which might influence diagnosis.
methodsCross-sectional observational study in all English local authorities (351) and general practices (8,372) comparing model-based expected prevalence with diagnosed prevalence on practice disease registers. Spatial analyses were used to identify geographic clusters and variation in regression relationships.
resultsA total of 9,682,176 patients were on practice CHD, stroke and transient ischaemic attack, and hypertension registers. There was wide spatial variation in observed: expected prevalence ratios for all three diseases, with less than five per cent of expected cases diagnosed in some areas. London and the surrounding area showed statistically significant discrepancies in observed: expected prevalence ratios, with observed prevalence much lower than the epidemiological models predicted. The addition of general practitioner supply as a variable yielded stronger regression results for all three conditions.
conclusionsDespite almost universal access to free primary healthcare, there may be significant and highly variable under-diagnosis of CVD across England, which can be partially explained by persistent inequity in GP supply. Disease management studies should consider the possible impact of under-diagnosis on population health outcomes. Compared to classical regression modelling, spatial analytic techniques can provide additional information on risk factors for under-diagnosis, and can suggest where healthcare resources may be most needed.
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