Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality.
OBJECTIVE
To explore the relation between rates of coronary artery revascularisation and prevalence of angina to assess whether use of health services reflects need.


METHODS
Prevalence of angina symptoms determined by postal questionnaire on 16750 subjects (18 to 94 years). Comparison of data on use of coronary artery revascularisation with prevalence of symptoms and mortality from coronary heart disease.


METHODS
Health authority with population of 530000.


METHODS
Patients admitted to hospital for coronary heart disease; patients who died; and patients undergoing angiography, angioplasty, or coronary artery bypass graft. Cohort of 491 people with symptoms from survey.


METHODS
Pearson's product moment correlation coefficients for relation between variables.


RESULTS
Overall, 4.0% (95% confidence interval 3.7% to 4.4%) of subjects had symptoms. Prevalences varied widely between electoral wards and were positively associated with Townsend score (r = 0.79; P < 0.001), as was mortality, but the correlation between admission rates and Townsend score was less clear (r = 0.47; P < 0.01). Revascularisation rate and Townsend score were not associated. The ratio of revascularisation to number experiencing symptoms was inversely related to Townsend score (r = 0.67; P < 0.001). The most deprived wards had only about half the number of revascularisations per head of population with angina than did the more affluent wards. In affluent wards 11% (13/116) of those with symptoms had coronary angiograms compared with only 4% (9/216) in poorer wards (chi 2 = 4.96; P = 0.026). Townsend score also inversely correlated with revascularisations per premature death from coronary heart disease (r = 0.55; P < 0.01) and revascularisations per admission for myocardial infarction (r = 0.47; P < 0.01).


CONCLUSIONS
The use of interventional cardiology services is not commensurate with need, thus exhibiting the inverse care law.
Payne
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N
Saul
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology* / Q000401:mortality; D017130:Angioplasty; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D004739:England / Q000453:epidemiology; D006301:Health Services Needs and Demand; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011203:Poverty; D015995:Prevalence; D013222:State Medicine