ArticleJournal of epidemiology and community health1995
Coronary revascularisation: why do rates vary geographically in the UK?
Article in Journal of epidemiology and community health, 1995. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effective management of stable angina.Quality in health care : QHC · 1998Pooled it
- Coronary artery bypass graft surgery: socioeconomic inequalities in access and in 30 day mortality. A population-based study in Rome, Italy.Journal of epidemiology and community health · 2000Trial
- Ethical issues with geographical variations in the provision of health care services.BMC medical ethics · 2022Article
- Catheter-related blood stream infections in hemodialysis patients: a prospective cohort study.BMC nephrology · 2017Article
- Trends of relative and absolute socioeconomic equity in access to coronary revascularisations in 1995-2010 in Finland: a register study.International journal for equity in health · 2017Article
- Article
- Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003-2013.Heart (British Cardiac Society) · 2016Article
- Referring patients with chronic noncancer pain to pain clinics: survey of Ontario family physicians.Canadian family physician Medecin de famille canadien · 2011Article
- South Asians and coronary heart disease: always bad news?The British journal of general practice : the journal of the Royal College of General Practitioners · 2011Article
- Hospital volume of throughput and periprocedural and medium-term adverse events after percutaneous coronary intervention: retrospective cohort study of all 17,417 procedures undertaken in Scotland, 1997-2003.Heart (British Cardiac Society) · 2006Article
- Differences in per capita rates of revascularization and in choice of revascularization procedure for eleven states.BMC health services research · 2006Article
- Who cares in England and Wales? The Positive Care Law: cross-sectional study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2004Article
- Socioeconomic deprivation is a predictor of poor postoperative cardiovascular outcomes in patients undergoing coronary artery bypass grafting.Heart (British Cardiac Society) · 2003Article
- Need for redefining needs.Health and quality of life outcomes · 2003Article
- Guidelines and management of mild hypertensive conditions in pregnancy in rural general practices in Scotland: issues of appropriateness and access.Quality & safety in health care · 2003Article
- Markers of access to and quality of primary care for aboriginal people in Ontario, Canada.American journal of public health · 2003Article
- Angioplasty, bypass surgery or medical treatment: how should we decide?Heart (British Cardiac Society) · 2002Article
- Socioeconomic variations in responses to chest pain: qualitative study.BMJ (Clinical research ed.) · 2002Article
- Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications.Heart (British Cardiac Society) · 2001Article
- Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain.Journal of epidemiology and community health · 2000Article
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3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo explain the reasons for geographical variation in the use of coronary revascularisation in the United Kingdom.
designThis was a cross sectional ecological study.
settingNHS and independent hospitals performing coronary revascularisation for the 11.6 million residents of the south east Thames, East Anglian and north western health regions in England plus Greater Glasgow, Lanarkshire, Ayr and Arran health boards in Scotland were included. SUBJECTS: All residents aged > or = 25 years in 1992-93 who underwent coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) in either the public or private sector were included. MAIN MEASURES: Crude and age-sex standardised intervention rates for residents of the 42 constituent districts and boards were determined. Variation was measured using the systematic component of variation.
resultsConsiderable systematic variations in district rates of CABG and PTCA existed. These variations mostly arose from differences in supply factors. Higher rate districts were characterised by being close to a regional revascularisation centre and having a local cardiologist. Demand factors such as the level of need in the population (measured by coronary heart disease mortality) and the lack of use of alternative treatments not only failed to explain the observed variation but were inversely associated with the rate of intervention--an example of the inverse care law. The finding that the residents of more socially deprived districts experienced higher intervention rates was probably subject to confounding due to their close proximity to specialist centres.
conclusionsIf greater geographical equity of use for the same level of need is to be achieved, attention must be paid to the supply factors that determine levels of utilisation. As responsibility for purchasing these procedures is decentralised, utilisation might become even more unequal.
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