Omoregbee Benjamin Irene, Kesieme Emeka B, Ngaage Dumbor L
Cardiac Surgery, Castle Hill Hospital, England, UK.
BMJ Public Health. 2025 Aug 22;3(2):e001336. doi: 10.1136/bmjph-2024-001336. eCollection 2025.
Variations and avoidable differences in healthcare between different geographical regions cause health inequality. Postcode lottery in population health could have implications for management of aortic valve disease, for which surgery is the standard of care. We examine disparities in the presentation and outcome of aortic valve replacement (AVR) between three postcode towns in North East England.
Clinical data for all patients who had AVR±other procedures at our institution between February 1999 and October 2022 were reviewed. Excluding those from outside our catchment area, we grouped patients according to their postcode towns, namely: Kingston upon Hull (HU), Doncaster (DN) and York (YO), with corresponding health index scores of 77.5, 91.5 and 105.2. We obtained the index of multiple deprivation (IMD) for the postcode towns and compared clinical presentation and in-hospital outcomes between the postcode towns and IMD deciles for their neighbourhoods.
There were 4639 patients (HU=1699, YO=1736, DN=1204). Compared with other postcode towns, more HU patients were unemployed and active smokers, and they often presented with advanced symptoms, cardiac failure and higher predicted operative risk. They also often underwent urgent or emergency operations and had longer postoperative hospital stays. However, in-hospital mortality was similar for patients from the three postcode towns. By IMD ranking, HU had the most deprived neighbourhood. Multivariable analysis did not identify postcode town or IMD decile as predictors of in-hospital mortality.
There are disparities in the clinical presentation and outcomes of AVR between the three postcode towns in North England which align with the level of multiple deprivation. These findings support postcode health inequalities in the surgical management of aortic valve disease and warrant policy-directed changes to enhance public awareness and timely access for aortic valve disease management.
不同地理区域之间医疗保健的差异和可避免的差别会导致健康不平等。人口健康方面的邮编抽奖可能会对主动脉瓣疾病的管理产生影响，而手术是该病的标准治疗方法。我们研究了英格兰东北部三个邮编城镇之间主动脉瓣置换术（AVR）的表现和结果差异。
回顾了1999年2月至2022年10月期间在我们机构接受AVR±其他手术的所有患者的临床数据。排除来自我们服务区域以外的患者，我们根据他们的邮编城镇对患者进行分组，即：赫尔河畔金斯敦（HU）、唐卡斯特（DN）和约克（YO），相应的健康指数得分分别为77.5、91.5和105.2。我们获取了邮编城镇的多重剥夺指数（IMD），并比较了邮编城镇及其邻里的IMD十分位数之间的临床表现和住院结局。
共有4639例患者（HU = 1699例，YO = 1736例，DN = 1204例）。与其他邮编城镇相比，更多的HU患者失业且是现吸烟者，他们常表现为晚期症状、心力衰竭且预测手术风险更高。他们也常接受急诊或紧急手术，术后住院时间更长。然而，三个邮编城镇的患者住院死亡率相似。按IMD排名，HU的邻里最贫困。多变量分析未将邮编城镇或IMD十分位数确定为住院死亡率的预测因素。
英格兰北部三个邮编城镇之间AVR的临床表现和结果存在差异，这与多重剥夺水平一致。这些发现支持了主动脉瓣疾病外科治疗中的邮编健康不平等，并需要政策导向的改变以提高公众意识并及时获得主动脉瓣疾病管理。
