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Title: Is there evidence of social inequity in healthcare for coronary heart disease? : an electronic-cohort analysis using record-linked, routine data
Author: King, William
ISNI:       0000 0004 5355 041X
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2015
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This study aimed to establish whether there was evidence of inequity in the utilisation of healthcare for coronary heart disease in the population of Wales during the period 2004 to 2010. Determining whether or not such inequity exists is important, because equity in healthcare is an aim of NHS services and, if present, inequity might contribute to the substantial differences in coronary-heart-disease mortality by deprivation that are seen in Wales. I used linked general practice, hospital admission, and mortality data from routine sources, and developed a distinctive methodology to evaluate the utilisation, timeliness, and maintenance of appropriate treatment, making comparisons across deprivation quintiles. My approach was based on analysing a pathway of care for coronary heart disease in a comprehensive way. At each stage in this pathway I examined ‘clinical triggers’ and the extent to which these were matched by appropriate ‘clinical actions’. Findings were broadly in accord with those in the published literature: using multivariate adjustment and taking account of supplyside- effects using frailty models, I detected no systematic evidence of inequity in coronary-heart-disease healthcare provision except in relation to revascularisation. As an illustration of this broad pattern, I found that the adjusted hazard ratio for times-to-receiving revascularisation in the most deprived quintile (compared to the least) was 0.83 (95% confidence interval 0.77; 0.91) in those with myocardial infarction. Further, I found no evidence that indicated prescriptions were reissued over a shorter time-period for more deprived individuals. In discussing this work, I consider possible explanations for my findings, and address the way that my distinctive methodology, which enabled measurement of important aspects of coronary-heart-disease care, might be applied in other areas. This work has important implications in demonstrating in a systematic and comprehensive way that healthcare inequity for coronary heart disease in the NHS is confined to specific interventions, and is unlikely to be contributing substantially to differences in mortality between deprivation groups.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: R Medicine (General)