title: The impact of social deprivation on coronary revascularisation treatment outcomes within the National Health Service in England and Wales.
abstract: BACKGROUND
  There is strong evidence to suggest that social deprivation is linked to health inequalities. In the UK, concerns have been raised regarding disparities in the outcomes of acute cardiac services within the National Health Service (NHS). This study explored whether differences exist in (a) elective hospital presentation time (b) indicators of severity and disease burden and (c) treatment outcomes (hospital stay and mortality) on the basis of the index of multiple deprivation (IMD) status.
  
  
  METHODS
  This study was a retrospective analysis of data from NHS databases for 13,758 patients that had undergone cardiac revascularisation interventions at the Liverpool Heart and Chest Hospital between April 2007-March 2012.
  
  
  METHODS
  The data was analysed by descriptive, univariate and multivariate statistics to explore the association between the IMD quintiles (Q1-Q5) and revascularisation type, elective presentation time, hospital length of stay and mortality.
  
  
  CONCLUSIONS
  Univariate analysis indicated that there were significant differences between patients from the most deprived areas (Q5) compared with patients from the least deprived areas (Q1), these included admission volumes, time before presentation to hospital and proportion of non-elective cases. After risk-adjustments, percutaneous coronary intervention patients from Q5 compared with Q1 had significantly greater length of hospital stay and risk of in-hospital major acute cardiovascular events. After multivariate adjustment for baseline risk factors, patients from Q5 were associated with significantly worse five-year survival as compared with Q1 (hazard ratio (HR) 1.52, 95% confidence interval (CI): 1.36-1.71; p < 0.001). In conclusion, there is evidence to suggest that inequalities in cardiac revascularisation choices and outcomes in the UK may be associated with social deprivation.
authors.affiliation: Liverpool Heart and Chest Hospital, UK bashir.matata@lhch.nhs.uk.
authors.forename: Bashir M
authors.initials: BM
authors.lastname: Matata
authors.affiliation: Liverpool Heart and Chest Hospital, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Liverpool Heart and Chest Hospital, UK.
authors.forename: Antony D
authors.initials: AD
authors.lastname: Grayson
authors.affiliation: Liverpool Heart and Chest Hospital, UK.
authors.forename: James
authors.initials: J
authors.lastname: McShane
authors.affiliation: Public Health Wales, UK.
authors.forename: John
authors.initials: J
authors.lastname: Lucy
authors.affiliation: Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Jackson
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D003327:Coronary Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D054625:Healthcare Disparities / Q000191:economics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D011203:Poverty; D011204:Poverty Areas; D017064:Process Assessment, Health Care / Q000191:economics; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013222:State Medicine / Q000191:economics; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014850:Waiting Lists; D014852:Wales
keywords: Coronary heart disease; acute cardiac services; burden of disease; cardiac interventions; index of multiple deprivation