The 130th Annual Meeting of APHA

Abstract #46075

Katrina Miriam Regnauld, Dr, Sue Payne, Dr, Peter Donnelly, MD MPH MBA FRCP, and Julie D Clark, BSc MPH. Public Health, Lothian NHS Board, Deaconess House, 148 Pleasance, Edinburgh, United Kingdom

Addressing health inequalities and utilising evidence-based research are high priorities on Scotland’s Public Health agenda. This study addresses these concerns by exploring geographical differences in rates of angiography and revascularisation for Coronary Heart Disease across geographical areas. This enables inequality to be recognised and effectively addressed – potentially improving treatment of this disease - Scotland’s second largest killer.

Edinburgh is divided into seven geographical units. Anecdotal evidence suggested that rates of angiography in one unit were below that of others. Because angiography is a diagnostic tool and a prerequisite for revascularisation, there was further concern that unequal access to angiography may result in unequal access to operative procedures.

A statistical investigation of the rates of angiography, coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA) and total revacularisation for the different geographical units was conducted, adjusting for both the population of, and the varying level of CHD (therefore need) in, each area. This produced a summary statistic for the ratio of actual : expected rate for each intervention that was then compared across the localities.

Results substantiated anecdotal reports that rates of angiography and revascularisation differed across Lothian and indicated that variations could not be explained primarily by differences in levels of need within the localities.

Providing evidence of geographical inequity confirmed anecdotal speculation, and was used to focus discussion on referral practice providing the impetus for resolution (strategies for which are presently under investigation).

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