BMJ  2003;327:1406 (13 December), doi:10.1136/bmj.327.7428.1406

Letter

Prognosis for South Asian and white patients with heart failure in the United Kingdom

Deprivation gradient in mortality should not be dismissed as artefactual

The first 150 words of the full text of this article appear below.

EDITOR—Blackledge et al report that, counterintuitively, socially deprived patients with heart failure have a better all cause mortality risk.1 This contradicts a large previous study in the United Kingdom showing a clear socioeconomic gradient in mortality risk favouring the least deprived patients.2

Blackledge et al suggest that their finding may be an artefact of the deprivation index they used (index of multiple deprivation 2000). However, misclassification error resulting from the use of any ecological deprivation index would influence results towards parity rather than produce a clear socioeconomic gradient. Although the results are significant only for the most deprived group, a test for trend using the deprivation score as a continuous variable is likely to have produced a significant result and could have been more informative.3

As the authors state, adverse health outcomes are concentrated in the elderly population subgroups of any given geographically defined population. Nevertheless, area based . . . [Full text of this article]

G Lyratzopoulos, lecturer in public health

georgios.lyratzopoulos@man.ac.uk, Evidence for Population Health Unit, School of Epidemiology and Health Sciences, Medical School, University of Manchester, Manchester M13 9PT

R F Heller, professor of public health

Evidence for Population Health Unit, School of Epidemiology and Health Sciences, Medical School, University of Manchester, Manchester M13 9PT


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Relevant Article

Prognosis for South Asian and white patients newly admitted to hospital with heart failure in the United Kingdom: historical cohort study
Hanna M Blackledge, James Newton, and Iain B Squire
BMJ 2003 327: 526-531. [Abstract] [Full Text] [PDF]

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