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

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

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.

access and utilisation, cardiovascular care, ethnicity, gender, inverse care, older people
0966-0410
259-272
Asthana, Sheena
e1840442-9c99-4fbb-994c-e9efbd9f6ea6
Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Gibson, Alex
f2bf89c4-0c0b-4677-a6eb-3978dac873a2
Bailey, Trevor
08b0a229-fbae-4fec-8a4d-675bf7d4ef47
Hewson, Paul
00ad18bb-b6e3-4a5c-b0c4-62e1823a22ea
Dibben, Chris
fd69f5d0-e346-4609-84d6-eb2bfcbfa4b7
Asthana, Sheena
e1840442-9c99-4fbb-994c-e9efbd9f6ea6
Moon, Graham
68cffc4d-72c1-41e9-b1fa-1570c5f3a0b4
Gibson, Alex
f2bf89c4-0c0b-4677-a6eb-3978dac873a2
Bailey, Trevor
08b0a229-fbae-4fec-8a4d-675bf7d4ef47
Hewson, Paul
00ad18bb-b6e3-4a5c-b0c4-62e1823a22ea
Dibben, Chris
fd69f5d0-e346-4609-84d6-eb2bfcbfa4b7

Asthana, Sheena, Moon, Graham, Gibson, Alex, Bailey, Trevor, Hewson, Paul and Dibben, Chris (2018) Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature. Health & Social Care in the Community, 26 (3), 259-272. (doi:10.1111/hsc.12384).

Record type: Review

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.

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More information

Accepted/In Press date: 11 July 2016
e-pub ahead of print date: 16 October 2016
Published date: 1 May 2018
Keywords: access and utilisation, cardiovascular care, ethnicity, gender, inverse care, older people

Identifiers

Local EPrints ID: 419823
URI: https://eprints.soton.ac.uk/id/eprint/419823
ISSN: 0966-0410
PURE UUID: 2bd1f0f6-9dc0-4b52-a06e-92f06807f256
ORCID for Graham Moon: ORCID iD orcid.org/0000-0002-7256-8397

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Date deposited: 23 Apr 2018 16:30
Last modified: 14 Mar 2019 01:41

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