Inequalities in access to and outcomes of cardiac surgery in England: retrospective analysis of Hospital Episode Statistics (2010-2019)

Objectives To characterise the variation in access to and outcomes of cardiac surgery for people in England. Methods We included people >18 years of age with a hospital admission for ischaemic heart disease (IHD) and heart valve disease (HVD) between 2010 and 2019. Within these populations, we identified patients who had coronary artery bypass graft (CABG) and/or valve surgery, respectively. We fitted logistic regression models to examine the effects of age, sex, ethnicity and socio-economic deprivation on having access to surgery and in-hospital mortality, 1-year mortality and hospital readmission. Results We included 292,140 people, of whom 28% were women, 11% were from an ethnic minority and 17% were from the most deprived areas. Across all types of surgery, 1 in 5 patients are readmitted to hospital within 1 year, rising to almost 1 in 4 for valve surgery patients. Women, Black people and people living in the most deprived areas were less likely to have access to surgery (CABG: 59%, 32%, 35% less likely; valve: 31%, 33%, 39% less likely, respectively) and more likely to die within 1 year of surgery (CABG: 24%, 85%, 18% more likely, respectively; valve: 19% (women) and 10% (people from most deprived areas) more likely). Conclusion Female sex, Black ethnicity, and economic deprivation are independently associated with limited access to cardiac surgery and higher post-surgery mortality. Actions are required to address these inequalities.   ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project is funded by a National Institute for Health Research (NIHR) Programme Development Grant (NIHR203304). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study uses Hospital Episode Statistics which are anonymised data used by the UK government for planning and recording healthcare. Formal ethical review is not required for this data product. For more information see: https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors