Observational studies have shown that health, quality of life, and outcomes of medical interventions are worse in patients from socially deprived areas.1 2 3 These inequities seem to apply in private and nationalised healthcare systems for a range of surgical procedures.4 5 The founding tenets of the NHS are fundamentally linked to redressing imbalances in health between people from different socioeconomic backgrounds. Our inability to achieve equity in health since the inception of the NHS more than 60 years ago weighs heavily on policy makers and the healthcare community.6 The emergence of large disease registers and procedure registers is likely to continue to highlight these inequities.

The linked study by Pagano and colleagues (doi:10.1136/bmj.b902) identifies significant differences in mortality between different socioeconomic groups in 44 902 patients during the index admission and five years after a range of cardiac surgical procedures.7 The authors used the census based Carstairs scores as a marker of social deprivation. This …