• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jepicomhInstructions for authorsCurrent TOCJournal of Epidemiology and Community Health
J Epidemiol Community Health. Sep 2000; 54(9): 714–718.
PMCID: PMC1731754

Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain

Abstract

OBJECTIVES—To 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.
DESIGN—Two 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.
SETTING—Glasgow conurbation.
PARTICIPANTS—1107 men and women, aged 45-64, with chest pain.
OUTCOME MEASURES—Prevalence 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.
RESULTS—There 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.
CONCLUSIONS—No 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

Full Text

The Full Text of this article is available as a PDF (135K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Payne N, Saul C. Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality. BMJ. 1997 Jan 25;314(7076):257–261. [PMC free article] [PubMed]
  • Black N, Langham S, Petticrew M. Coronary revascularisation: why do rates vary geographically in the UK? J Epidemiol Community Health. 1995 Aug;49(4):408–412. [PMC free article] [PubMed]
  • MacLeod MC, Finlayson AR, Pell JP, Findlay IN. Geographic, demographic, and socioeconomic variations in the investigation and management of coronary heart disease in Scotland. Heart. 1999 Mar;81(3):252–256. [PMC free article] [PubMed]
  • Majeed FA, Cook DG. Age and sex differences in the management of ischaemic heart disease. Public Health. 1996 Jan;110(1):7–12. [PubMed]
  • Dong W, Ben-Shlomo Y, Colhoun H, Chaturvedi N. Gender differences in accessing cardiac surgery across England: a cross-sectional analysis of the health survey for England. Soc Sci Med. 1998 Dec;47(11):1773–1780. [PubMed]
  • Spencer I, Unwin N, Pledger G. Hospital investigation of men and women treated for angina. BMJ. 1995 Jun 17;310(6994):1576–1576. [PMC free article] [PubMed]
  • Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999 May 8;353(9164):1547–1557. [PubMed]
  • Womersley J. The public health uses of the Scottish Community Health Index (CHI). J Public Health Med. 1996 Dec;18(4):465–472. [PubMed]
  • Rose G, McCartney P, Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med. 1977 Mar;31(1):42–48. [PMC free article] [PubMed]
  • Hobbs R. Deprivation payments. BMJ. 1993 Feb 27;306(6877):534–535. [PMC free article] [PubMed]
  • Hart CL, Watt GC, Davey Smith G, Gillis CR, Hawthorne VM. Pre-existing ischaemic heart disease and ischaemic heart disease mortality in women compared with men. Int J Epidemiol. 1997 Jun;26(3):508–515. [PubMed]
  • Lampe FC, Whincup PH, Wannamethee SG, Ebrahim S, Walker M, Shaper AG. Chest pain on questionnaire and prediction of major ischaemic heart disease events in men. Eur Heart J. 1998 Jan;19(1):63–73. [PubMed]
  • ROSE GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962;27:645–658. [PMC free article] [PubMed]
  • Hlatky MA, Mark DB, Califf RM, Pryor DB. Angina, myocardial ischemia and coronary disease: gold standards, operational definitions and correlations. J Clin Epidemiol. 1989;42(5):381–384. [PubMed]
  • Sullivan AK, Holdright DR, Wright CA, Sparrow JL, Cunningham D, Fox KM. Chest pain in women: clinical, investigative, and prognostic features. BMJ. 1994 Apr 2;308(6933):883–886. [PMC free article] [PubMed]
  • Smith WC, Kenicer MB, Tunstall-Pedoe H, Clark EC, Crombie IK. Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study. Br Heart J. 1990 Nov;64(5):295–298. [PMC free article] [PubMed]
  • Hawthorne VM, Watt GC, Hart CL, Hole DJ, Smith GD, Gillis CR. Cardiorespiratory disease in men and women in urban Scotland: baseline characteristics of the Renfrew/Paisley (midspan) study population. Scott Med J. 1995 Aug;40(4):102–107. [PubMed]
  • Morrison C, Woodward M, Leslie W, Tunstall-Pedoe H. Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register. BMJ. 1997 Feb 22;314(7080):541–546. [PMC free article] [PubMed]
  • Payne JN, Coy J, Milner PC, Patterson S. Are deprivation indicators a proxy for morbidity? A comparison of the prevalence of arthritis, depression, dyspepsia, obesity and respiratory symptoms with unemployment rates and Jarman scores. J Public Health Med. 1993 Jun;15(2):161–170. [PubMed]
  • Wun YT, Chan K, Lee A. Co-morbidity in general practice. Fam Pract. 1998 Jun;15(3):266–268. [PubMed]
  • Carr-Hill RA, Rice N, Roland M. Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. BMJ. 1996 Apr 20;312(7037):1008–1012. [PMC free article] [PubMed]
  • McKinlay JB, Potter DA, Feldman HA. Non-medical influences on medical decision-making. Soc Sci Med. 1996 Mar;42(5):769–776. [PubMed]
  • Griffiths F. Women's health concerns. Is the promotion of hormone replacement therapy for prevention important to women? Fam Pract. 1995 Mar;12(1):54–59. [PubMed]
  • Kandrack MA, Grant KR, Segall A. Gender differences in health related behaviour: some unanswered questions. Soc Sci Med. 1991;32(5):579–590. [PubMed]
  • Hibbard JH, Pope CR. Another look at sex differences in the use of medical care: illness orientation and the types of morbidities for which services are used. Women Health. 1986 Summer;11(2):21–36. [PubMed]
  • Sayer GP, Britt H. Sex differences in morbidity: a case of discrimination in general practice. Soc Sci Med. 1996 Jan;42(2):257–264. [PubMed]
  • Lyons R, Payne C, McCabe M, Fielder C. Legibility of doctors' handwriting: quantitative comparative study. BMJ. 1998 Sep 26;317(7162):863–864. [PMC free article] [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...