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Coronary revascularisation: why do rates vary geographically in the UK?
N Black1, S Langham, M Petticrew
1Department of Public Health and Policy, London School of Hygiene and Tropical Medicine.
Journal of Epidemiology and Community Health
|August 1, 1995
Summary
Geographical variations in coronary revascularisation, including coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA), are primarily driven by supply-side factors, not patient need. Addressing these supply factors is crucial for achieving equitable access to cardiac procedures.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Geographical Epidemiology
Background:
- Coronary revascularisation procedures, such as coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA), exhibit significant geographical variations in utilization across the United Kingdom.
- Understanding the drivers behind these disparities is essential for promoting equitable healthcare access.
Purpose of the Study:
- To investigate the underlying reasons for geographical variations in the rates of coronary revascularisation procedures in the UK.
- To determine whether supply-side factors or demand-side factors are more influential in driving these observed geographical differences.
Main Methods:
- A cross-sectional ecological study was conducted, analyzing data from NHS and independent hospitals across specified health regions in England and Scotland.
- Intervention rates for coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) were calculated for residents aged 25 years and older.
- Systematic variations were quantified using the systematic component of variation, controlling for age and sex.
Main Results:
- Significant geographical variations in CABG and PTCA rates were identified across districts.
- These variations were predominantly explained by supply-side factors, including proximity to revascularisation centers and the presence of local cardiologists.
- Demand-side factors, such as coronary heart disease mortality and use of alternative treatments, did not explain the variation and were inversely associated with intervention rates, suggesting an inverse care law phenomenon.
Conclusions:
- Supply-side factors are the primary determinants of geographical inequity in coronary revascularisation utilization.
- Decentralization of purchasing decisions for these procedures may exacerbate existing inequalities in access.
- Future efforts to achieve geographical equity must focus on addressing supply-side influences on service provision.