Exploring ethnic inequalities in cardiovascular disease using Hospital Episode Statistics
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This thesis is based on a population study conducted to explore ethnic inequalities in cardiovascular disease using Hospital Episode Statistics (HES). The Hospital Episode Statistics have significant potential for health studies for ethnic groups, due to the large number of events from minority ethnic groups, comprehensive clinical information, full England coverage and fine geographical scale. However, the percentage of Finished Consultant Episodes (FCEs) with invalid ethnicity codes is at a high level. This thesis starts by developing a record linkage method and a coding rate method to improve the data quality of ethnicity codes in the HES. This thesis then further examines ethnic inequalities in cardiovascular disease incidence in England at both national and local geographical scales. The patterns of ethnic inequalities in cardiovascular disease appear to have changed little in the last ten years. However, large variations of geographical relative risk of cardiovascular disease were observed for ethnicity-sex groups. The relationships between areal socioeconomic status measured at different geographical scales and ethnic inequalities in different types of cardiovascular disease were also explored. As there are very limited data on the mortality of minority ethnic groups in the UK, few studies have compared the incidence and outcome of cardiovascular disease from the same population. This thesis came up with some novel findings, for example, that people from minority ethnic groups, who generally have increased risk of cardiovascular disease incidence, have better cardiovascular disease survival than white people. The contribution of areal socioeconomic status, distance to treatment sites and cardiovascular disease severity and treatment to the ethnic inequalities in cardiovascular survival was examined. The relationships between socioeconomic status measured at different geographical scales and ethnic inequalities in cardiovascular disease severity and treatment were investigated in this thesis as well.
Thesis, PhD Doctor of Philosophy
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