Mind the Gap - Socio-Economic and Gender Inequalities in Service Delivery and Mortality inpatients Hospitalised with Acute Coronary Syndrome - PhD thesis

Aug 26, 2026

Coronary heart disease remains the leading cause of death in most countries and is strongly shaped by health inequalities. This PhD thesis investigates socioeconomic and sex disparities in patients presenting characteristics, treatment patterns, and all-cause mortality among individuals hospitalised with myocardial infarction or angina. The work comprises four independent but related studies combining systematic review and linked cohort analyses. Evidence shows lower socioeconomic status is linked to higher 30-day and 1-year mortality and reduced access to invasive procedures.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages267

Reading Time11 h 13 min

AccessFree to download

Abstract

Systematic review (study 1)

Aims

Methods and results

Conclusion

Cohort study in West of Scotland (study 2)

Aim

Methods and results

Conclusion

Zhang, Ruiqi (2022) Mind the gap: socio-economic and gender inequalities in service delivery and mortality inpatients hospitalised with Acute Coronary Syndrome. PhD thesis. [https://theses.gla.ac.uk/82981/](https://theses.gla.ac.uk/82981/) Copyright and moral rights for this work are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This work cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Enlighten: Theses [https://theses.gla.ac.uk/](https://theses.gla.ac.uk/) [research-enlighten@glasgow.ac.uk](research-enlighten@glasgow.ac.uk) Mind the Gap: Socio-Economic and Gender Inequalities in Service Delivery and Mortality in Patients Hospitalised with Acute Coronary Syndrome Ruiqi Zhang Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Institute of Health & Wellbeing School of Medicine, Veterinary and Life Sciences University of Glasgow Abstract Coronary heart disease persists as the leading cause of death in most countries and is severely affected by health inequalities. This thesis examined socioeconomic and sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina. It is composed of four independent but related studies. Socioeconomic status and its association with healthcare and mortality after acute coronary syndrome: a systematic review (study 1) Aims: In the first section of the thesis, a systematic review was conducted to determine the associations of SES with mortality and access to invasive cardiac procedures after ACS hospitalisation. Methods and results: Electronic databases (Ovid Medline® and Embase) were searched in December 2017. The impact of SES was analysed separately for each outcome: 1) all-cause mortality at 30 days and at 1 year; 2) use of invasive cardiac procedures during hospitalisation split by coronary angiography (CAG) and percutaneous coronary intervention (PCI) . Meta-analyses were conducted using random effects models. Subgroup analysis were performed to separate any differences across different measures of SES, countries of study, final diagnosis and year of publication. Sixty studies were included. The overall results of the meta-analyses provided evidence for significantly higher risk of death among ACS patients in lower socioeconomic categories for both 30-day and 1-year mortality. Compared to ACS patients of the highest socioeconomic position, the risk of death at 30-days in the lowest group increased by 24%(RR 1.24, 95% confidence interval (CI) 1.17- 1.31) . The lowest socioeconomic category was also associated with increased risk of death at 1-year (RR 1.20, 95% CI 1.14-1.26) . Socioeconomic disparities were also found in invasive cardiac procedure rates in patients hospitalised with ACS. Overall, groups with the poorest level of SES had reduced access to coronary angiography (RR 0.70, 95% CI 0.59-0.82) and PCI (RR 0.82, 95% CI 0.74- 0.90) . Results were consistent across subgroup and sensitivity analyses. Conclusion: In patients with ACS, it is well established that a person’s socioeconomic status has modest but profound effects on the utilisation of invasive cardiovascular services and mortality. These relationships have been demonstrated for different dimensions of area-level and individual level SES measures, across different countries and have not improved over time. Differences in mortality across socioeconomic strata is greatly attenuated after considering treatments and related factors, while targeting poor geograp

FAQs

What is the main research focus of the thesis?

The thesis examines how socioeconomic status and sex influence presenting characteristics, treatment, and all-cause mortality in patients hospitalised with acute coronary syndrome, including myocardial infarction and angina.

How were socioeconomic differences in mortality assessed in the first study?

A systematic review searched electronic databases and used meta-analyses with random effects, analyzing all-cause mortality at 30 days and 1 year separately and performing subgroup analyses across multiple stratifications.

What treatment access differences were found across socioeconomic groups?

Lower socioeconomic categories showed reduced access to coronary angiography and percutaneous coronary intervention, with results consistent across subgroup and sensitivity analyses.

Aug 26, 2026

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