Inequalities in socio-economic status and invasive procedures for coronary heart disease: a comparison between the USA and the UK

BACKGROUND: Coronary heart disease (CHD) is a serious health problem in the USA and UK. Low socio-economic status (SES) has been associated with an increased prevalence of CHD and also with inequalities in related health outcomes. Rates of utilisation of invasive coronary procedures (ICPs), which improve CHD outcomes and quality of life, can be employed as indicators of quality of medical care. OBJECTIVES: To investigate and compare inequalities in care experienced by low SES CHD patients in the US Medicaid programme and the UK National Health Service (NHS) in relation to waiting times for, and access to, ICPs. Possible ways of addressing SES inequalities are proposed. SETTING/SUBJECT: Coronary heart disease patients eligible for ICPs in the US Medicaid programme and the UK NHS. METHODS: A systematic literature search was performed for relevant SES inequalities. Data from 43 sources were analysed. RESULTS: Both countries exhibited differences in waiting times for coronary angiography (CA) and percutaneous transluminal coronary angioplasty/coronary artery bypass graft (PTCA)/(CABG). Low SES patients waited longer than high SES patients within each country. The disparity in CHD care between low and high SES patients within each country appeared to be similar. Low SES patients in both countries experienced reduced rates of CA and CABG/PTCA. IMPLICATIONS/CONCLUSION: Despite differences between the US third-party payer system and the UK socialised, primary care-oriented system, each country faces the same SES inequalities regarding waiting time for and access to the ICPs. Understanding the reasons behind these inequalities is vital to address them.