J Epidemiol Community Health 2000;54:714-718 ( September )

Public health policy and practice

Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain Helen Richards^a, Alex McConnachie^a, Caroline Morrison^b, Keith Murray^c, Graham Watt^a

^a Department of General Practice, University of Glasgow, 4 Lancaster Crescent, Glasgow G12 ORR, ^b Greater Glasgow Health Board, ^c Department of Public Health, University of Glasgow

Correspondence to: Dr Richards (hmr3r{at}clinmed.gla.ac.uk)

Accepted for publication 10 May 2000

OBJECTIVESTo describe the prevalence of Rose angina and non-exertional chest pain in men and women in socioeconomically contrasting areas; to describe the proportions of men and women who present with the symptom of chest pain and who receive a provisional general practitioner diagnosis of coronary heart disease; to assess the effects of gender and deprivation.
DESIGNTwo random general population samples in socially contrasting areas were surveyed using the Rose angina questionnaire: the case notes of people identified with chest pain were reviewed.
SETTINGGlasgow conurbation.
PARTICIPANTS1107 men and women, aged 45-64, with chest pain.
OUTCOME MEASURESPrevalence of Rose angina and non-exertional chest pain; the proportions who had presented with chest pain and received a general practitioner's provisional diagnosis of coronary heart disease.
RESULTSThere was no difference between social groups in the prevalence of all chest pain but a greater proportion of those in deprived groups had Rose angina and a greater proportion of these had the more severe grade. The proportion of people who had presented with chest pain was higher among socioeconomically deprived groups but there was no difference in the proportions receiving a general practitioner provisional diagnosis of coronary heart disease. Men were more likely to present with chest pain than women and were more likely to receive a provisional general practitioner diagnosis of coronary heart disease.
CONCLUSIONSNo evidence was found of social differences in patient presentation or general practitioner diagnosis that might explain reported variations in uptake of cardiology services. In contrast, gender variation may originate in part from differences in patient presentation and general practitioner diagnosis. Further investigation of socioeconomic variations in uptake of cardiology services should focus later in the care pathway, on general practitioner referral patterns and clinical decisions taken in secondary care.


Keywords: angina; social class; gender; primary care; chest pain

---

© 2000 by Journal of Epidemiology and Community Health
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Emslie, C., Hunt, K. (2009). Men, Masculinities and Heart Disease: A Systematic Review of the Qualitative Literature. Current Sociology 57: 155-191 [Abstract]  
• Bowling, A., Reeves, B., Rowe, G. (2008). Patient preferences for treatment for angina: an overview of findings from three studies. J Health Serv Res Policy 13: 104-108 [Abstract] [Full Text]  
• Ashworth, M., Lloyd, D., Smith, R. S., Wagner, A., Rowlands, G. (2007). Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner 'Quality and Outcomes Framework'. J Public Health (Oxf) 29: 40-47 [Abstract] [Full Text]  
• Murphy, N F, Stewart, S, Hart, C L, MacIntyre, K, Hole, D, McMurray, J J V (2006). A population study of the long-term consequences of Rose angina: 20-year follow-up of the Renfrew-Paisley study. Heart 92: 1739-1746 [Abstract] [Full Text]  
• Hannaford, P. C, Smith, B. H, Elliott, A. M (2006). Primary care epidemiology: its scope and purpose. Fam Pract 23: 1-7 [Full Text]  
• Vaccarino, V. (2006). Angina and Cardiac Care: Are There Gender Differences, and If So, Why?. Circulation 113: 467-469 [Full Text]  
• Leyland, A. H (2005). Socioeconomic gradients in the prevalence of cardiovascular disease in Scotland: the roles of composition and context. J. Epidemiol. Community Health 59: 799-803 [Abstract] [Full Text]  
• Fahey, T. (2004). Valuable insights from morbidity coding in primary care. BMJ 328: 1113-1113 [Full Text]  
• Richards, H., Reid, M., Watt, G. (2003). Victim-blaming revisited: a qualitative study of beliefs about illness causation, and responses to chest pain. Fam Pract 20: 711-716 [Abstract] [Full Text]  
• Hemingway, H., Shipley, M., Britton, A., Page, M., Macfarlane, P., Marmot, M. (2003). Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study. BMJ 327: 895- [Abstract] [Full Text]  
• Richards, H. M., Reid, M. E., Watt, G. C. M. (2002). Socioeconomic variations in responses to chest pain: qualitative study. BMJ 324: 1308-1308 [Abstract] [Full Text]