Article Text

Download PDFPDF
High rates of ischaemic heart disease in Scotland are not explained by conventional risk factors
  1. Richard Mitchell1,
  2. Gerry Fowkes2,
  3. David Blane3,
  4. Mel Bartley4
  1. 1Research Unit in Health, Behaviour and Change, University of Edinburgh Medical School, UK
  2. 2Public Health Sciences, University of Edinburgh Medical School
  3. 3Department of Primary Care and Social Medicine, Imperial College London, UK
  4. 4Department of Epidemiology and Public Health, University College London, UK
  1. Correspondence to:
 Dr R Mitchell
 Research Unit in Health, Behaviour and Change, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK;


Study objectives: To (1) compare prevalence of socioeconomic, behavioural, and physiological ischaemic heart disease (IHD) risk factors in Scotland with a comparable nation (England) and (2) find out if their distribution explains Scotland’s comparatively higher IHD rate (1.62 (1.30, 2.02)).

Design, setting, and participants: Cross sectional, individual level observational study with data on socioeconomic, behavioural, and physiological characteristics, 6064 respondents from Scotland and England, (2362 and 3702 respectively), aged 45–74 and with data on all required items.

Main results: There were significant and meaningful differences between the Scottish and English in the prevalence of several IHD risk factors. However, a substantially and significantly higher risk of IHD persisted among the Scottish respondents (1.50 (1.17, 1.91)) despite control for a wide range of risk factors.

Conclusions: Interpretation must be cautious because these are cross sectional data, however higher levels of conventional IHD risk factors contribute to but do not explain the comparatively high rates of IHD in Scotland. Alternative explanations for, and policy interventions to tackle, Scottish rates of IHD must be considered.

  • IHD, ischaemic heart disease
  • GHQ, general health questionnaire
  • heart disease
  • inequalities
  • Scotland
  • risk

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: RM and The Research Unit in Health, Behaviour and Change is funded by the Chief Scientist Office of The Scottish Executive Health Department (SEHD) and NHS Health Scotland. The opinions expressed in this paper are those of the author(s) not of SEHD or HEBS. Mel Bartley was funded by ESRC grant no R000 27 112 and MRC grant no G8802744.

  • Conflicts of interest: none declared

  • Ethical approval: approval was sought and obtained from the research ethics committees for all area health boards in Scotland before fieldwork started on the 1998 SHS. Ethical approval for the 1998 HSE was obtained from the North Thames Multi-centre Research Ethics Committee and from all local research ethics committees in England. No ethical approval was required for this secondary analysis.

Linked Articles