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Journal of Public Health Advance Access originally published online on January 25, 2006
Journal of Public Health 2006 28(1):39-42; doi:10.1093/pubmed/fdi065
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework



Mark Strong
M. Strong, Specialist Registrar in Public Health Medicine, Rotherham Primary Care Trust, Oak House, Moorhead Way, Bramley, Rotherham S66 1YY, UK


Ravi Maheswaran
R. Maheswaran, Clinical Senior Lecturer in Public Health Medicine, Public Health GIS Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK


John Radford
J. Radford, Director of Public Health, Rotherham Primary Care Trust, Oak House, Moorhead Way, Bramley, Rotherham S66 1YY, UK

Address correspondence to Mark Strong. Email: mark.strong{at}rotherhampct.nhs.uk

Background The provision of coronary heart disease (CHD) health care has been shown to be inequitous, with those most in need having the least access to high-quality care. The new UK general practitioner (GP) Quality and Outcomes Framework (QOF) contract offers substantial financial rewards to general practices that combine maximal CHD case finding with high-quality CHD care.

Objective To examine whether GP practice-level CHD prevalence and the measures of quality of care derived from the new QOF data are associated with area-level socioeconomic deprivation.

Methods An ecological study of 38 GP practices contracting with Rotherham Primary Care Trust, United Kingdom, was carried out. We calculated Spearman rank correlation coefficients for practice-level age–sex-standardized QOF CHD prevalence against area deprivation score and for 11 QOF CHD indicator achievements against area deprivation score.

Results Practice-level CHD prevalence showed a positive correlation with deprivation (r=0.64, p<0.001), as did one of the 11 quality-of-care indicators (recording of smoking status, r=0.34, p=0.04). The remaining 10 quality-of-care indicators showed no significant correlation with deprivation.

Conclusion Practice-level CHD prevalence is associated with deprivation, but we found no evidence of socioeconomic inequality in CHD care. This finding is in contrast to that from previous studies and the widely reported inverse care law.

Keywords: coronary disease, primary health care, quality of health care, socioeconomic factors


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