Care provision in England doesn't match regional variation in heart disease, study shows

BMJ 2007; 334 doi: (Published 10 May 2007) Cite this as: BMJ 2007;334:970
  1. Roger Dobson
  1. Abergavenny

    A new study that compared the prevalence of heart disease in different areas in England with the number of revascularisation procedures carried shows a mismatch between the two.

    Some affluent areas with a low prevalence of disease had greater provision of procedures than more deprived areas with a high prevalence, says the study, published online in Health & Place (doi: 10.1016/j.healthplace.2007.04.003).

    The study looked at data on prevalence of heart disease and on mortality from 1999 and from 2003, as well as 2001 census data, taking into account socioeconomic data. It estimated the prevalence of heart disease by age, sex, and ethnicity for each of 354 English local authority areas.

    The results show a clear divide in prevalence between the North and the South and between affluent and poor areas. With few exceptions, areas north of a line between the River Severn and the Wash have a higher prevalence of heart disease, and deprived areas tend to have higher prevalence than more affluent ones.

    The study then looked at variation in the availability of revascularisation procedures. “Assessment of health care interventions is often based simply on league table rankings without any reference to morbidity, or indeed mortality. A useful application of prevalence measures is in assessing how far intervention rates correspond with health need,” says the report.

    The 2002 data showed that there were 42 000 such procedures in men and 16 000 in women. The results show some discrepancies between provision of the procedure and local prevalence of heart disease.

    The report says that some relatively affluent areas with a low prevalence of disease, such as Bedfordshire, Hertfordshire, Surrey, and Sussex, have an above average provision of revascularisation, while some high prevalence areas, including Cheshire, Merseyside, Greater Manchester, Shropshire, and Staffordshire, seem to have poorer provision.

    “It is important to note that revascularisation treatments have been shown to be beneficial for subjects with coronary heart disease in terms of outcomes such as exercise tolerance and quality of life,” says the report.

    (See Feature doi: 10.1136/bmj.39204.639711.94)

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