NHS cannot stop social factors behind CHD rate

Variation in CHD mortality is largely caused by population factors, rather than quality of healthcare, a study has shown.

CHD: affected by social factors (Photograph: SPL)
CHD: affected by social factors (Photograph: SPL)

Researchers from the University of Leicester found risk of death from CHD was strongly linked to the level of deprivation, smoking, white ethnicity and diabetes in a PCT's population.

In comparison, only one service characteristic - the level of detected hypertension - improved this outcome.

The research supports NICE's warning that DoH plans to judge commissioning on outcomes may be unfair because outcomes are affected by factors outside the control of the NHS (GP, 5 November).

Evidence linking service characteristics to risk of CHD mortality could help inform improved healthcare, the authors explained.

They correlated population characteristics, including social and health determinants, with levels of CHD death in the UK between 2006 and 2008.

The findings showed programmes to reduce mortality 'should address those characteristics of populations amenable to intervention, including smoking and deprivation', the authors said.

The link between detected hypertension and reduced CHD mortality shows the importance of monitoring population level factors, they said. But they added: 'The extent to which primary healthcare services can affect these population factors is not certain.'

Responding to the research, NICE said the study was 'the latest in a significant number' to highlight the importance of focusing on inequalities caused by socioeconomic factors.

Commenting on plans to assess consortia on outcomes, GPC deputy chairman Dr Richard Vautrey said practices in deprived areas had always struggled to hit targets.

'The important thing is to understand that health inequalities can only truly be tackled by investing in education, housing, employment opportunities and a better environment,' he said.

'Tackle these and it is also likely that there will be falls in smoking, alcohol abuse and obesity, all causes of health inequality.'

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Stephen Robinson

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JAMA 2010; 304: 2,028-34

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