{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T14:09:31Z","timestamp":1782396571011,"version":"3.54.5"},"reference-count":21,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"unspecified","delay-in-days":52,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,6,16]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Variations and avoidable differences in healthcare between different geographical regions cause health inequality. Postcode lottery in population health could have implications for management of aortic valve disease, for which surgery is the standard of care. We examine disparities in the presentation and outcome of aortic valve replacement (AVR) between three postcode towns in North East England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data for all patients who had AVR\u00b1other procedures at our institution between February 1999 and October 2022 were reviewed. Excluding those from outside our catchment area, we grouped patients according to their postcode towns, namely: Kingston upon Hull (HU), Doncaster (DN) and York (YO), with corresponding health index scores of 77.5, 91.5 and 105.2. We obtained the index of multiple deprivation (IMD) for the postcode towns and compared clinical presentation and in-hospital outcomes between the postcode towns and IMD deciles for their neighbourhoods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 4639 patients (HU=1699, YO=1736, DN=1204). Compared with other postcode towns, more HU patients were unemployed and active smokers, and they often presented with advanced symptoms, cardiac failure and higher predicted operative risk. They also often underwent urgent or emergency operations and had longer postoperative hospital stays. However, in-hospital mortality was similar for patients from the three postcode towns. By IMD ranking, HU had the most deprived neighbourhood. Multivariable analysis did not identify postcode town or IMD decile as predictors of in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There are disparities in the clinical presentation and outcomes of AVR between the three postcode towns in North England which align with the level of multiple deprivation. These findings support postcode health inequalities in the surgical management of aortic valve disease and warrant policy-directed changes to enhance public awareness and timely access for aortic valve disease management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001336","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T10:45:26Z","timestamp":1755859526000},"page":"e001336","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Postcode health inequalities in aortic valve surgery in North East England: retrospective study of disparities in presentation and hospital outcomes"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6014-0502","authenticated-orcid":false,"given":"Benjamin Irene","family":"Omoregbee","sequence":"first","affiliation":[{"name":"Cardiac Surgery, Castle Hill Hospital, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emeka B.","family":"Kesieme","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Castle Hill Hospital, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2378-7160","authenticated-orcid":false,"given":"Dumbor L.","family":"Ngaage","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Castle Hill Hospital, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"2026010703064012000_3.2.e001336.1","doi-asserted-by":"crossref","unstructured":"Marmot M . 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Available: https:\/\/imd-by-postcode.opendatacommunities.org\/imd\/2019 [Accessed 8 Jan 2025]."},{"key":"2026010703064012000_3.2.e001336.11","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1001\/jama.294.22.2879","article-title":"Socioeconomic status in health research: One size does not fit all","volume":"294","author":"Braveman","year":"2006","journal-title":"JAMA"},{"key":"2026010703064012000_3.2.e001336.12","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000228"},{"key":"2026010703064012000_3.2.e001336.13","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2009.163"},{"key":"2026010703064012000_3.2.e001336.14","doi-asserted-by":"crossref","first-page":"e748","DOI":"10.1016\/S2214-109X(19)30045-2","article-title":"Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study","volume":"7","author":"Rosengren","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2026010703064012000_3.2.e001336.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029652"},{"key":"2026010703064012000_3.2.e001336.16","unstructured":"WHO Health Commission . Closing the gap in a generation: health equity through action on the social determinants of health \u2013 final report of the csdh. World Health Organization; 2008."},{"key":"2026010703064012000_3.2.e001336.17","unstructured":"NICE and health inequality. Available: https:\/\/www.nice.org.uk\/about\/what-we-do\/nice-and-health-inequalities [Accessed 25 Feb 2024]."},{"key":"2026010703064012000_3.2.e001336.18","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2023-002373","article-title":"Impact of gender, ethnicity and social deprivation on access to surgical or transcatheter aortic valve replacement in aortic stenosis: a retrospective database study in England","volume":"10","author":"Rice","year":"2023","journal-title":"Open Heart"},{"key":"2026010703064012000_3.2.e001336.19","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2024-324292"},{"key":"2026010703064012000_3.2.e001336.20","first-page":"844","article-title":"Inequity in Access to Transcatheter Aortic Valve Replacement: A Pan-Canadian Evaluation of Wait-Times","volume":"36","author":"Wijeysundera","year":"2020","journal-title":"Can J Cardiol"},{"key":"2026010703064012000_3.2.e001336.21","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1001\/jamacardio.2021.4641","article-title":"Racial, Ethnic, and Socioeconomic Disparities in Access to Transcatheter Aortic Valve Replacement Within Major Metropolitan Areas","volume":"7","author":"Nathan","year":"2022","journal-title":"JAMA Cardiol"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2024-001336","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:08:28Z","timestamp":1767784108000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2024-001336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,8,22]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjph-2024-001336"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2024-001336","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}