Influence of practices' ethnicity and deprivation on access to angiography: an ecological study.

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.