title: Influence of practices' ethnicity and deprivation on access to angiography: an ecological study.
abstract: BACKGROUND
  Coronary heart disease is more common among some ethnic minority groups (particularly people from the Indian sub-continent living in Europe and North America) and in socially deprived populations. Hospital studies in the United Kingdom (UK) suggest that these groups have less access to treatment for coronary heart disease. Studies from primary care have found reduced access to angiography for lower social class groups, but there are no studies on the ethnicity of primary care populations in relation to angiography.
  
  
  OBJECTIVE
  To determine the influence of ethnicity and social deprivation in primary care on access to coronary angiography.
  
  
  METHODS
  Ecological study measuring general practices' ethnicity, socioeconomic status, and nitrate prescribing rates with angiography rates.
  
  
  METHODS
  General practices (n = 143) in East London, UK.
  
  
  METHODS
  Ecological study measuring the proportion of general practice populations with South Asian ethnicity and high social deprivation score (Carstairs). Nitrate prescriptions and admissions for myocardial infarction per 1000 population per year were used as measures of need. Distance from the tertiary centre was used as a measure of supply. The outcome measure was coronary angiography procedures data (n = 869) collected in the context of the appropriateness of coronary revascularisation study.
  
  
  RESULTS
  Practices with a higher proportion of South Asian patients had higher rates of angiography after adjustment for age, distance, deprivation, nitrate prescribing and myocardial infarction admissions (regression coefficient B = 0.02, 95% confidence interval [CI] = 0.01 to 0.03, P<0.001). There was no association between deprivation and angiography (regression coefficient B = -0.41, 95% CI = -0.13 to 0.05, P = 0.393).
  
  
  CONCLUSIONS
  General practices with a higher proportion of South Asian patients had higher rates of angiography, challenging the widely held belief that access may be inequitable. Deprivation shows no relationship with angiography in this study.
authors.affiliation: Department of Primary Care and Population Sciences, Royal Free and UC Medical Schools, London. m.jones@pcps.ucl.ac.uk
authors.forename: Melvyn
authors.initials: M
authors.lastname: Jones
authors.forename: Jean
authors.initials: J
authors.lastname: Ramsay
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
authors.forename: Angela M
authors.initials: AM
authors.lastname: Crook
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans