Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature

Abstract

There is a general understanding that socioeconomically disadvantaged people are also disadvantaged with respect to their access to NHS care. Insofar as considerable NHS funding has been targeted at deprived areas, it is important to better understand whether and why socioeconomic variations in access and utilisation exist. Exploring this question with reference to cardiovascular care, our aims were to synthesise and evaluate evidence relating to access to and/or use of English NHS services around (i) different points on the care pathway (i.e. presentation, primary management and specialist management) and (ii) different dimensions of inequality (socioeconomic, age- and gender-related, ethnic or geographical). Restricting our search period from 2004 to 2016, we were concerned to examine whether, compared to earlier research, there has been a change in the focus of research examining inequalities in cardiac care and whether the pro-rich bias reported in the late 1990s and early 2000s still applies today. We conducted a scoping study drawing on Arksey & O'Malley's framework. A total of 174 studies were included in the review and appraised for methodological quality. Although, in the past decade, there has been a shift in research focus away from gender and age inequalities in access/use and towards socioeconomic status and ethnicity, evidence that deprived people are less likely to access and use cardiovascular care is very contradictory. Patterns of use appear to vary by ethnicity; South Asian populations enjoying higher access, black populations lower. By contrast, female gender and older age are consistently associated with inequity in cardiovascular care. The degree of geographical variation in access/use is also striking. Finally, evidence of inequality increases with stage on the care pathway, which may indicate that barriers to access arise from the way in which health professionals are adjudicating health needs rather than a failure to seek help in the first place.

Factors Associated with Utilization of Primary and Specialist Healthcare Services by Elderly Cardiovascular Patients in the Republic of Serbia: A Cross-Sectional Study from the National Health Survey 2013

“…The scientific literature on healthcare utilization inequalities for elderly patients with CVD is sparse. Asthana et al performed a scoping review on inequity in cardiovascular care in the English National Health Service and found that females and older persons are consistently being associated with lower than expected rates of access to and use of cardiovascular care, South Asian populations having higher access while black populations lower access to care [43]. They found the geographical variation in access/use to be striking, and that barriers to access erected by healthcare professionals explain their results, rather than patients' failure to seek help in the first place.…”

How Educational Inequalities in Cardiovascular Mortality Evolve While Healthcare Insurance Coverage Grows: Colombia, 1998 to 2015

“…Likewise, CVD mortality has been shown to be higher among those with better use of secondary prevention 36 ; different patterns in access and use of cardiovascular care by socioeconomic status and ethnicity has been found 53 as well as different specialized health service utilization. 54 Previous studies evidenced that major reductions in CVD mortality have been reached by controlling risk factors such as total cholesterol, blood pressure, smoking, and physical inactivity, and by contributing to the disease treatment, 55 although the importance of these contributions is still disputed.…”

Aortic valve intervention rates in patients of different ethnicity with severe aortic stenosis in Leicestershire, UK

“…In the US, Black and Latinos are relatively under-represented in the primary healthcare system and less likely to be referred to cardiologists or cardiac surgeons. However, a review of cardiovascular care delivered in the National Health Service (NHS) in the UK has shown that Asians have higher levels of presentation and better access to secondary care management 22 but not necessarily primary care than other ethnic minority groups. 23 …”