Inequity in cardiovascular care in the English National Health Service (NHS)

A scoping review of the literature

Bibliographic Data

ID14947879
AuthorsSheena Asthana (0000-0002-1483-2719, School of Government; University of Plymouth; Plymouth UK, corresponding author), Graham Moon (0000-0002-7256-8397, School of Geography and the Environment; University of Southampton; Southampton UK), Alex Gibson (0000-0003-2761-2819, School of Government; University of Plymouth; Plymouth UK), Trevor Bailey (Mathematics and Physical Sciences; University of Exeter; Exeter UK), Paul Hewson (0000-0002-2093-229X, School of Computing and Mathematics; University of Plymouth; Plymouth UK), Chris Dibben (0000-0003-1769-3774, School of Geosciences; University of Edinburgh; Edinburgh UK)
Year2018
Volume26
Issue3
Pages259-272
Publication date2018-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth & Social Care in the Community (JOURNAL)
Journal identifiersISSN: 0966-0410 • E-ISSN: 1365-2524
PublisherHindawi Limited (PUBLISHER)
DOI10.1111/hsc.12384
PMID27747961
OpenAlexW2537980476
LanguageEN
Citations received1
References cited120

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

Disadvantaged · Environmental health · Ethnic group · Inequality · Political science · Population · Socioeconomic status · Health Promotion and Cardiovascular Prevention · Healthcare Policy and Management · Medicine · Primary Care and Health Outcomes · Psychology · Gerontology

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