Inequalities in access to and outcomes of cardiac surgery in England: retrospective analysis of Hospital Episode Statistics (2010-2019).

Autor:	Lai FY; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK., Gibbison B; Cardiac Anaesthesia and Intensive Care, Bristol Medical School, University of Bristol, Bristol, UK., O'Cathain A; Sheffield Health Centre for Health and Related Research, The University of Sheffield, Sheffield, UK., Akowuah E; Department of Cardiac Surgery, the James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK., Cleland JG; Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Wellebing, University of Glasgow, Glasgow, UK., Angelini GD; Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK., King C; Bristol Heart Institute, University of Bristol, Bristol, UK., Murphy GJ; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK., Pufulete M; Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK maria.pufulete@bristol.ac.uk.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2024 Oct 10; Vol. 110 (21), pp. 1262-1269. Date of Electronic Publication: 2024 Oct 10.
DOI:	10.1136/heartjnl-2024-324292
Abstrakt:	Background: We aimed to characterise the variation in access to and outcomes of cardiac surgery for people in England. Methods: We included people >18 years of age with hospital admission for ischaemic heart disease (IHD) and heart valve disease (HVD) between 2010 and 2019. Within these populations, we identified people who had coronary artery bypass graft (CABG) and/or valve surgery, respectively. We fitted logistic regression models to examine the effects of age, sex, ethnicity and socioeconomic deprivation on having access to surgery and in-hospital mortality, 1-year mortality and hospital readmission. Results: We included 292 140 people, of whom 28% were women, 11% were from an ethnic minority and 17% were from the most deprived areas. Across all types of surgery, one in five people are readmitted to hospital within 1 year, rising to almost one in four for valve surgery. Women, black people and people living in the most deprived areas were less likely to have access to surgery (CABG: 59%, 32% and 35% less likely; valve: 31%, 33% and 39% less likely, respectively) and more likely to die within 1 year of surgery (CABG: 24%, 85% and 18% more likely, respectively; valve: 19% (women) and 10% (people from most deprived areas) more likely). Conclusions: Female sex, black ethnicity and economic deprivation are independently associated with limited access to cardiac surgery and higher post-surgery mortality. Actions are required to address these inequalities. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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