title: Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study.
abstract: OBJECTIVE
  Investigate the association between socioeconomic deprivation and completeness of cardiovascular disease (CVD) risk factor recording in primary care, uptake of screening in people with incomplete risk factor recording and with actual CVD risk within the screened subgroup.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Nine UK general practices.
  
  
  METHODS
  7987 people aged 50-74 years with no CVD diagnosis.
  
  
  METHODS
  CVD risk was estimated using the Framingham equation from data extracted from primary care electronic health records. Where there was insufficient information to calculate risk, patients were invited to attend a screening assessment.
  
  
  METHODS
  Proportion of patients for whom clinical data were sufficiently complete to enable CVD risk to be calculated; proportion of patients invited to screening who attended; proportion of patients who attended screening whose 10-year risk of a cardiovascular event was high (>20%). For each outcome, a set of logistic regression models were run. Crude and adjusted ORs were estimated for person-level deprivation, age, gender and smoking status. We included practice-level deprivation as a continuous variable and practice as a random effect to account for clustering.
  
  
  RESULTS
  People who had lower Indices of Multiple Deprivation (IMD) scores (less deprived) had significantly worse routine CVD risk factor recording (adjusted OR 0.97 (0.95 to 1.00) per IMD decile; p=0.042). Screening attendance was poorer in those with more deprivation (adjusted OR 0.89 (0.86 to 0.91) per IMD decile; p<0.001). Among those who attended screening, the most deprived were more likely to have CVD risk >20% (OR 1.09 (1.03 to 1.15) per IMD decile; p=0.004).
  
  
  CONCLUSIONS
  Our data suggest that those who had the most to gain from screening were least likely to attend, potentially exacerbating existing health inequalities. Future research should focus on tailoring the delivery of CVD screening to ensure engagement of socioeconomically deprived groups.
authors.affiliation: General Practice & Primary Care Research Unit, University of Cambridge, Cambridge, UK.
authors.forename: Sarah-Jane
authors.identifier: http://orcid.org/0000-0002-4342-7165
authors.initials: SJ
authors.lastname: Lang
authors.affiliation: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Abel
authors.affiliation: General Practice & Primary Care Research Unit, University of Cambridge, Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.affiliation: General Practice & Primary Care Research Unit, University of Cambridge, Cambridge, UK.
authors.forename: Ricky
authors.initials: R
authors.lastname: Mullis
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011322:Primary Prevention; D012307:Risk Factors; D012959:Socioeconomic Factors; D006113:United Kingdom
keywords: PREVENTIVE MEDICINE; PRIMARY CARE; PUBLIC HEALTH