ACCESS TO CORONARY CATHETERIZATION - FAIR SHARES FOR ALL

Objective-To determine the effects of patient's sex and area's materia l deprivation on utilisation rates of coronary catheterisation and ang iography in the investigation of ischaemic heart disease. Design-Retro spective analysis of routinely collected hospital statistics. Setting- Acute hospitals throughout Northern Ireland. Subjects-24179 episodes o f patients discharged from hospital with a primary diagnosis of ischae mic heart disease and 1270 episodes relating to patients with an under lying diagnosis of ischaemic heart disease who had either coronary cat heterisation or angiography. Main outcome measures-Age standardised ad mission rates for heart disease and age standardised utilisation rates for catheterisation or angiography, or both, for 566 electoral wards ranked by Townsend ''deprivation'' scores. Results-Catheterisation-ang iography rates in men were over fivefold those of women, ranging from 85.5/100000 v 16/100000 in patients from ''well off'' areas to 123/100 000 v 22/100000 for patients from deprived areas. After admission rate s for heart disease were controlled for, the overall rate ratio for wo men was 0.48 (95% confidence interval 0.38 to 0.60). After differentia l admission rates for heart disease and other potential clinical confo unders were controlled for, the investigation rates of patients from t he least and most ''deprived'' areas were not significantly different (rate ratio 1.04 (0.87 to 1.25)). Conclusion-Although investigation ra tes were significantly lower in women than in men, further clinical da ta would be required before labelling this underutilisation as evidenc e of bias. There was no significant difference in invasive investigati on rates for heart disease in areas of varying deprivation or affluenc e.