Background The incidence of coronary heart disease (CHD) has declined in the UK since the late 1970s. However, regional differences in this decline are unknown. We investigate the change in CHD incidence from the period 1980–1988 to 2000–2008 according to UK region. We also examine regional differences in changes in established coronary risk factors over these periods
Methods The British Regional Heart Study recruited 7735 men between 1978 and 1980 when aged 40–59 from 24 British towns. Established risk factors were measured at baseline examination and on 4252 participants twenty years later (1998–2000). CHD incidence over eight years from baseline was compared with incidence over eight years following re-examination. Age-adjusted Cox regression models including an interaction between an indicator for time period and region were used to assess relative hazards of CHD incidence between the two time periods according to UK region: South England (7 towns), Midlands/Wales (4 towns), North England (10 towns) and Scotland (3 towns).. Age-adjusted linear and logistic models with the same interaction term assessed changes in risk factors between the two periods according to region.
Results CHD incidence for 1980–1988 in the South, Midlands/Wales, North and Scotland was 0.6, 0.8, 0.9 and 1.1 per 100 person years, and 1.1, 1.5, 1.3, and 1.1 for 2000–2008 when participants were 20 years older. Age-adjusted hazard ratios for the second versus first period in the four regions were 0.40, 0.50, 0.32 and 0.22 (p for interaction = 0.05), indicating that age-adjusted CHD incidence declined considerably in all regions but most rapidly among Scottish towns. While risk factor profiles were more favourable in the South than other regions in the first period, evidence of period/regional interactions were found in the analysis of some risk factors. Compared with the South, statistically significantly faster declines occurred in mean systolic blood pressure for North England and Scotland (by 3.1 mmHg and 4.1 mmHg respectively), in mean total cholesterol for Midlands/Wales (0.24 mmol/l), in smoking for Scotland (ratio of odds ratios 0.74), and faster increases in moderate physical activity in North England and Scotland (ratio of odds ratios 1.20 and 1.41 respectively). However mean BMI increased similarly across all regions.
Conclusion Fall in CHD incidence was faster in the Scottish towns than the English towns. An impressive improvement in coronary risk profiles was likely to be responsible, especially with respect to blood pressure, smoking and physical activity.
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