SUPER PROFILE ANALYSIS OF SOCIOECONOMIC VARIATIONS IN CORONARY INVESTIGATION AND REVASCULARIZATION RATES

Objectives-To investigate socioeconomic variations in the utilisation of tertiary cardiology services. Design-Cross sectional ecological stu dy, using the Super Profile classification of enumeration districts, a nd ischaemic heart disease standardised mortality ratios as a proxy fo r need. Setting-The former Yorkshire Regional Health Authority area in England and its seven constituent district health authority areas. Su bjects-Patients with a primary diagnosis of ischaemic heart disease ag ed greater than or equal to 25 years who underwent investigation by an giography, or treatment by coronary artery bypass grafting (CABG) or p ercutaneous transluminal coronary angioplasty (PTCA), as a primary pro cedure between April 1992 and March 1994 in an NHS hospital. Main resu lts-There is an overall increasing trend in investigation and revascul arisation rates from the affluent to the deprived in the region sugges ting equity. However, the gradient is slight compared with the corresp onding mortality gradient. Age specific analysis shows a more appropri ate trend in rates for the under 65s, but a downward trend from afflue nce to deprivation for the elderly. Much of the regional trend is caus ed by very high rates in one geographically small but densely populate d district that has two tertiary cardiology centres. In other district s, with higher heart disease mortality but much lower procedure rates, there is a decreasing trend from the affluent to the deprived suggest ing considerable inequity. Conclusions-This study confirms wide socioe conomic variations in coronary investigation and revascularisation wit hin the former Yorkshire Region, suggesting that in some districts nee d is not being met and that service utilisation is inequitable. Such i nequities are over and above those that result from proximity to terti ary cardiology centres.