Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort studyCommentary: Three decades of the inverse care law
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7226.15 (Published 01 January 2000) Cite this as: BMJ 2000;320:15
Abstract
Objective: To determine whether the priority given to patients referred for cardiac surgery is associated with socioeconomic status.
Design: Retrospective study with multivariate logistic regression analysis of the association between deprivation and classification of urgency with allowance for age, sex, and type of operation. Multivariate linear regression analysis was used to determine association between deprivation and waiting time within each category of urgency, with allowance for age, sex, and type of operation.
Setting: NHS waiting lists in Scotland.
Participants: 26 642 patients waiting for cardiac surgery, 1 January 1986 to 31 December 1997.
Main outcome measures: Deprivation as measured by Carstairs deprivation category. Time spent on NHS waiting list.
Results: Patients who were most deprived tended to be younger and were more likely to be female. Patients in deprivation categories 6 and 7 (most deprived) waited about three weeks longer for surgery than those in category 1 (mean difference 24 days, 95% confidence interval 15 to 32). Deprived patients had an odds ratio of 0.5 (0.46 to 0.61) for having their operations classified as urgent compared with the least deprived, after allowance for age, sex, and type of operation. When urgent and routine cases were considered separately, there was no significant difference in waiting times between the most and least deprived categories.
Conclusions: Socioeconomically deprived patients are thought to be more likely to develop coronary heart disease but are less likely to be investigated and offered surgery once it has developed. Such patients may be further disadvantaged by having to wait longer for surgery because of being given lower priority.
Footnotes
- Accepted 24 September 1999
Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study
- Jill P Pell (jill.pell{at}glasgow-hb.scot.nhs.uk), honorary senior lecturera,
- Alastair C H Pell, consultant cardiologistb,
- John Norrie, senior statisticianc,
- Ian Ford, directorc,
- Stuart M Cobbe, Walton professor of medical cardiologya
- aDepartment of Cardiology, Glasgow Royal Infirmary, Glasgow G31 2ER
- bDepartment of Cardiology, Monklands Hospital, Airdrie ML6 0JS
- cRobertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ
- Welsh Institute for Health and Social Care, University of Glamorgan, Glyntaff Campus, Pontypridd, Wales CF37 1DL
- Correspondence to: J Pell, Greater Glasgow Health Board, Dalian House, 350 St Vincents Street, Glasgow G3 8YU
- Accepted 24 September 1999
Abstract
Objective: To determine whether the priority given to patients referred for cardiac surgery is associated with socioeconomic status.
Design: Retrospective study with multivariate logistic regression analysis of the association between deprivation and classification of urgency with allowance for age, sex, and type of operation. Multivariate linear regression analysis was used to determine association between deprivation and waiting time within each category of urgency, with allowance for age, sex, and type of operation.
Setting: NHS waiting lists in Scotland.
Participants: 26 642 patients waiting for cardiac surgery, 1 January 1986 to 31 December 1997.
Main outcome measures: Deprivation as measured by Carstairs deprivation category. Time spent on NHS waiting list.
Results: Patients who were most deprived tended to be younger and were more likely to be female. Patients in deprivation categories 6 and 7 (most deprived) waited about three weeks longer for surgery than those in category 1 (mean difference 24 days, 95% confidence interval 15 to 32). Deprived patients had an odds ratio of 0.5 (0.46 to 0.61) for having their operations classified as urgent compared with the least deprived, after allowance for age, sex, and type of operation. When urgent and routine cases were considered separately, there was no significant difference in waiting times between the most and least deprived categories.
Conclusions: Socioeconomically deprived patients are thought to be more likely to develop coronary heart disease but are less likely to be investigated and offered surgery once it has developed. Such patients may be further disadvantaged by having to wait longer for surgery because of being given lower priority.
Footnotes
Funding Chief Scientist's Office of the Scottish Executive's Department of Health.
Competing interests None declared.
- Accepted 24 September 1999
Commentary: Three decades of the inverse care law
- Julian Tudor Hart (crustyhart{at}aol.com), external professor
- aDepartment of Cardiology, Glasgow Royal Infirmary, Glasgow G31 2ER
- bDepartment of Cardiology, Monklands Hospital, Airdrie ML6 0JS
- cRobertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ
- Welsh Institute for Health and Social Care, University of Glamorgan, Glyntaff Campus, Pontypridd, Wales CF37 1DL