{
  "abstract": "Introduction Studies indicate sociodemographic disparities in the rates of intervention for aortic stenosis (AS) in England. This study aims to explore the sociodemographic characteristics of those with a first coded diagnosis of AS within a primary care database, and the rates of referral to secondary care and aortic valve intreventions, by sex, ethnicity and socioeconomic status (SES).Methods Clinical Practice Research Datalink (CPRD) Aurum data was linked to Hospital Episode Statistics (HES). All patients aged ≥18 years with a first AS diagnostic code in primary or secondary care between 2000–2022 were included. Ethnicity was classified using CPRD and HES, while index of multiple deprivation (IMD), derived from postcodes, served as a proxy for SES. Rates of referral to secondary Cardiology/Cardiac Surgery care and aortic valve intervention was modelled using Royston-Parmar survival analysis, comparing groups by sex, SES, and ethnicity, adjusted for age and other sociodemographic co-variates.Results A total of 154,223 patients with a first diagnosis of AS were included (50.4% female, 92.7% White, 2.7% South Asian, 1.4% Black, 1.1% of Other/Mixed ethnicities). Women were older at diagnosis and those from ethnic minority groups and the most deprived IMD quintile were younger. A greater proportion of White patients with AS were in the least deprived IMD quintile, whilst the majority of ethnic minority groups were in the most deprived ( table 1). Most AS diagnoses (~80%) occurred first in primary care. Clinical characteristics by ethnicity are outlined in table 2. Referral to secondary cardiac care was recorded for 28% of patients (26% of women vs. 29% of men, p<0.001), with a median referral time from diagnosis of 17 months. Referral rates were lower in women vs. men (HR 0.89; 95% CI 0.88 to 0.91) and most deprived compared to least deprived group (HR 0.93; 95% CI 0.90 to 0.96), but higher among South Asian (HR 1.31; 95% CI 1.24 to 1.38) and Black patients (HR 1.21; 95% CI 1.12 to 1.31), compared to White patients. Compared to their respective counterparts, rates of aortic valve interventions were lower in women (HR 0.61; 95% CI 0.60 to 0.62), ethnic minority groups (South Asian: HR 0.73; 95% CI 0.68 to 0.78; Black: HR 0.52; 95% CI 0.46 to 0.58), with the difference being non-significant for the most deprived group (HR 0.97; 95% CI 0.94 to 1.01). After additional adjustment for comorbidities, this became significant (HR 0.96 (0.92, 0.99)) (figure 1).Conclusions Women and the most deprived patients are less likely to be referred to secondary care after an AS diagnosis and less likely to undergo an aortic valve intervention. On the contrary, South Asian and Black patients are more likely to be referred to secondary cardiac care, but less likely to undergo aortic valve intervention, which may reflect referral for non-AS related aetiology. A limitation of this analysis is the lack of AS severity data within the CPRD. Further research is needed to investigate the reasons for these differences.Abstract 1-007 Table 1Sociodemographic characteristics Total White South Asian Black n=154,223 n =143,053 n =4,238 n =2,233 Age at diagnosis (years)77 (68, 84)77 (68, 84)70 (59, 78)73 (59, 80)Female77,721 (50.4%)72,161 (50.4%)1,965 (46.4%)1,232 (55.2%) Index of Multiple Deprivation level 1(least deprived)35,422 (23.0%)33,684 (23.6%)552 (13.0%)83 (3.7%)234,645 (22.5%)32,830 (23.0%)642 (15.1%)154 (6.9%)330,863 (20.0%)28,602 (20.0%)913 (21.5%)355 (15.9%)428,318 (18.4%)25,552 (17.9%)1,124 (26.5%)783 (35.1%)5 (most deprived)24,822 (16.1%)22,245 (15.6%)1,007 (23.8%)856 (38.4%)Data are presented as mean (±SD) or median (IQR) for continuous measures, and n (%) for categorical measuresAbstract 1-007 Table 2Clinical characteristics Total White South Asian Black n=154,223 n =143,053 n =4,238 n =2,233 Ischaemic heart disease53,028 (34.4%)49,524 (34.6%)1,708 (40.3%)615 (27.5%)Hypertension104,001 (67.4%)96,858 (67.7%)3,014 (71.1%)1,721 (77.1%)Atrial fibrillation32,821 (21.3%)31,516 (22.0%)391 (9.2%)211 (9.4%)Stroke14,588 (9.5%)13,686 (9.6%)369 (8.7%)223 (10.0%)Diabetes35,398 (23.0%)31,714 (22.2%)1,926 (45.4%)895 (40.1%)Chronic kidney disease44,728 (29.0%)42,238 (29.5%)999 (23.6%)471 (21.1%)Chronic lung disease45,956 (29.8%)43,151 (30.2%)1,386 (32.7%)541 (24.2%)Smoker/Ex-smoker66,072 (42.8%)62,944 (44.0%)1,066 (25.2%)622 (27.9%)BMI (kg/m2)27.2 (24.1–30.9)27 (24, 31)27 (24, 30)29 (25, 33)Abstract 1-007 Figure 1Forest plot showing adjusted hazard ratios for referral to secondary cardiology/cardiac surgery services and aortic valve intervention where the reference group for ethnic groups is the white group, males for females and index of multiple deprivation (IMD) is level 1 (most affluent group)",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"
      ],
      "name": "Saadia Aslam"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"
      ],
      "name": "Harini Sathanapally"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"
      ],
      "name": "Gerry P McCann"
    },
    {
      "affiliations": [
        "Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK"
      ],
      "name": "Kamlesh Khunti"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"
      ],
      "name": "Claire Lawson"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK"
      ],
      "name": "Anvesha Singh"
    }
  ],
  "title": "1-007 Sociodemographic characteristics, referral and treatment rates of those with aortic stenosis in primary care; a CPRD population based study in England",
  "uid": "0d010dfe-ed33-54d9-b1cf-c70227b4cd87"
}