Tong, T. orcid.org/0000-0002-9307-6850, Maheswaran, R. orcid.org/0000-0002-3899-4421, Michaels, J. orcid.org/0000-0002-3422-7102 et al. (3 more authors) (2023) Socioeconomic disparities in surgery for carotid artery disease in England. BJS Open, 7 (4). zrad056. ISSN 2474-9842
Abstract
Background
Carotid artery disease and stroke are more prevalent in socioeconomically deprived areas. The aim was to investigate socioeconomic disparities in carotid artery disease surgery rates and in outcomes following surgery.
Methods
The study used population-based ecological and cohort study designs, 31 672 census areas in England, hospital admissions from April 2006 to March 2018, the Index of Multiple Deprivation 2010 as the area-level deprivation indicator, and Poisson, logistic, and Cox regression.
Results
A total of 54 377 patients (67 per cent men) from a population aged 55 years and older of 14.7 million had carotid artery disease procedures (95 per cent carotid endarterectomy). Carotid endarterectomy rates were 116 per cent (95% c.i. 101 to 132) higher in men and 180 per cent (95% c.i. 155 to 207) higher in women aged 55–64 years in the most compared with the least socioeconomically deprived areas by quintile. However, this difference diminished and appeared to reverse with increasing age, with 24 per cent (95% c.i. 14 to 33) and 12 per cent (95% c.i. −3 to 24) lower carotid endarterectomy rates respectively in men and women aged 85 years and older in the most deprived areas. Patients in deprived areas having carotid endarterectomy were more likely to have been admitted as symptomatic emergency carotid artery disease admissions. Mortality, and a combined outcome of mortality or stroke-related re-admission, were both worse in patients living in more deprived areas and were only partially accounted for by the higher prevalence of co-morbidities. There was, however, no clear pattern of association between deprivation and elective waiting time for carotid endarterectomy.
Conclusions
These results provide evidence of socioeconomic disparities in surgery for carotid artery disease. Clear policies are needed to address these disparities.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2023 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | Male; Humans; Female; Socioeconomic Disparities in Health; Cohort Studies; Carotid Artery Diseases; Stroke; England |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health The University of Sheffield > Faculty of Social Sciences (Sheffield) > Department of Landscape Architecture (Sheffield) |
Funding Information: | Funder Grant number DEPARTMENT OF HEALTH AND SOCIAL CARE UNSPECIFIED NATIONAL INSTITUTE FOR HEALTH RESEARCH UNSPECIFIED NATIONAL INSTITUTE FOR HEALTH RESEARCH UNSPECIFIED NATIONAL INSTITUTE FOR HEALTH RESEARCH UNSPECIFIED NATIONAL INSTITUTE FOR HEALTH RESEARCH NIHR VASCUALAR SERV |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 01 Dec 2023 09:54 |
Last Modified: | 01 Dec 2023 09:54 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1093/bjsopen/zrad056 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:205785 |