Related Experiment Video
Updated: Aug 24, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Influence of practices' ethnicity and deprivation on access to angiography: an ecological study
Melvyn Jones1, Jean Ramsay, Gene Feder
1Department of Primary Care and Population Sciences, Royal Free and UC Medical Schools, London. m.jones@pcps.ucl.ac.uk
Insights
This study found that general practices with more South Asian patients had higher rates of coronary angiography, contrary to beliefs of inequitable access. Social deprivation did not show a relationship with angiography rates.
Area of Science:
- Cardiovascular disease epidemiology
- Health services research
- Health equity
Background:
- Coronary heart disease (CHD) disproportionately affects ethnic minorities and socially deprived populations.
- Previous UK hospital studies suggest reduced access to CHD treatment for these groups.
- Limited research exists on primary care access to coronary angiography based on ethnicity.
Purpose of the Study:
- To investigate the impact of patient ethnicity and social deprivation on access to coronary angiography within UK primary care settings.
- To examine if South Asian ethnicity or social deprivation influences referral rates for coronary angiography.
Main Methods:
- Ecological study design involving 143 general practices in East London, UK.
- Measured practice-level South Asian population proportion, social deprivation (Carstairs score), and need indicators (nitrate prescriptions, myocardial infarction admissions).
- Coronary angiography procedure data (n=869) served as the outcome measure, adjusted for age, distance to tertiary center, and need.
Main Results:
- Practices with a higher proportion of South Asian patients demonstrated significantly higher rates of coronary angiography (B = 0.02, P<0.001).
- No significant association was found between social deprivation and coronary angiography rates (B = -0.41, P=0.393).
- Findings challenge assumptions of inequitable access to angiography for South Asian populations in this primary care context.
Conclusions:
- Higher rates of coronary angiography in practices serving larger South Asian populations suggest equitable access, contradicting prior beliefs.
- Social deprivation was not associated with access to coronary angiography in this East London primary care study.
- Further research is needed to confirm these findings across different healthcare systems and ethnic groups.
Background:
Coronary heart disease is more common among some ethnic minority groups (particularly people from the Indian sub-continent living in Europe and North America) and in socially deprived populations. Hospital studies in the United Kingdom (UK) suggest that these groups have less access to treatment for coronary heart disease. Studies from primary care have found reduced access to angiography for lower social class groups, but there are no studies on the ethnicity of primary care populations in relation to angiography.
Aims:
To determine the influence of ethnicity and social deprivation in primary care on access to coronary angiography.
Design Of Study:
Ecological study measuring general practices' ethnicity, socioeconomic status, and nitrate prescribing rates with angiography rates.
Setting:
General practices (n = 143) in East London, UK.
Method:
Ecological study measuring the proportion of general practice populations with South Asian ethnicity and high social deprivation score (Carstairs). Nitrate prescriptions and admissions for myocardial infarction per 1000 population per year were used as measures of need. Distance from the tertiary centre was used as a measure of supply. The outcome measure was coronary angiography procedures data (n = 869) collected in the context of the appropriateness of coronary revascularisation study.
Results:
Practices with a higher proportion of South Asian patients had higher rates of angiography after adjustment for age, distance, deprivation, nitrate prescribing and myocardial infarction admissions (regression coefficient B = 0.02, 95% confidence interval [CI] = 0.01 to 0.03, P<0.001). There was no association between deprivation and angiography (regression coefficient B = -0.41, 95% CI = -0.13 to 0.05, P = 0.393).
Conclusion:
General practices with a higher proportion of South Asian patients had higher rates of angiography, challenging the widely held belief that access may be inequitable. Deprivation shows no relationship with angiography in this study.
