Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study

BMJ : British Medical Journal
Annie BrittonHarry Hemingway

Abstract

To determine whether access to cardiac procedures and drugs contributes to social and ethnic differences in coronary heart disease in a population setting. Prospective study with follow up over 15 years. Civil service employment grade was used as a measure of individual socioeconomic position. Need for cardiac care was determined by the presence of angina, myocardial infarction, and coronary risk factors. 20 civil service departments originally located in London. 10,308 civil servants (3414 women; 560 South Asian) aged 35-55 years at baseline in 1985-8. Use of exercise electrocardiography, coronary angiography, and coronary revascularisation procedures and secondary prevention drugs. Inverse social gradients existed in incident coronary morbidity and mortality. South Asian participants also had higher rates than white participants. After adjustment for clinical need, social position showed no association with the use of cardiac procedures or secondary prevention drugs. For example, men in the low versus high employment grade had an age adjusted odds ratio for angiography of 1.87 (95% confidence interval 1.32 to 2.64), which decreased to 1.27 (0.83 to 1.94) on adjustment for clinical need. South Asians tended to be more likely t...Continue Reading

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Citations

Mar 25, 2010·JAMA : the Journal of the American Medical Association·Silvia StringhiniArchana Singh-Manoux
Oct 28, 2008·Journal of General Internal Medicine·Christopher MillettAzeem Majeed
Nov 17, 2006·Journal of Epidemiology and Community Health·M A DenvirJ P Pell
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Feb 7, 2008·International Journal of Cardiology·Konstantinos TziomalosAlexander M Seifalian
Nov 21, 2007·International Journal of Cardiology·Therese TillinAlun Hughes
Oct 6, 2005·The Milbank Quarterly·Barbara StarfieldJames Macinko
Sep 8, 2007·Community Dentistry and Oral Epidemiology·Joaquim Murilo Silveira Neto, Paulo Nadanovsky
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Apr 2, 2015·European Journal of Public Health·Adriana SudzinovaSijmen A Reijneveld
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Oct 18, 2016·Health & Social Care in the Community·Sheena AsthanaChris Dibben
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Mar 14, 2013·Circulation. Cardiovascular Quality and Outcomes·Nathaniel M HawkinsSimon Capewell

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