Objective: To examine whether social inequalities in all-cause and coronary heart disease (CHD) mortality in Britain have reduced between 1978 and 2005.
Design: A prospective study of a socioeconomically representative population.
Setting: 24 British towns.
Participants: 7735 Men, aged 40–59 years at recruitment in 1978–1980 and followed up until 2005 through the National Health Service Central Register (164 120 person-years).
Main outcome measures: Relative hazards and absolute risk differences for all-cause and CHD death comparing manual with non-manual social classes, calculated for different calendar periods.
Results: 3009 Deaths from all causes (1003 from CHD) occurred during follow-up. The overall hazard ratio (manual versus non-manual) was 1.56 (95% CI 1.45 to 1.69, p<0.001) for all-cause mortality and 1.54 (95% CI 1.35 to 1.76, p<0.001) for CHD mortality. The relative difference between these social groups tended to increase over time. The overall relative increase in hazard ratio comparing manual with non-manual groups over a 20-year calendar period was 1.22 (95% CI 0.83 to 1.80, p = 0.31) for all-cause mortality and 1.75 (95% CI 0.89 to 3.45, p = 0.11) for CHD mortality. The absolute difference in probability of survival to age 65 years between non-manual and manual groups fell from 29% in 1981 to 19% in 2001 for all-cause mortality and from 17% to 7% for CHD mortality.
Conclusion: Relative differences in all-cause and CHD mortality between manual and non-manual social class groups persisted and may have increased during this period. Absolute differences in mortality between these social groups decreased as a result of falling overall mortality rates. Greater effort is needed to reduce social inequalities in all-cause and CHD mortality in the new millennium.
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Competing interests: None.
Funding: The British Regional Heart Study is a British Heart Foundation Research Group. SR is funded by a UK MRC Special Training Fellowship in Health Services Research and Health of the Public.
Ethics approval: The British Regional Heart Study has local (from each of the districts in which the study was based) and multicentre ethical committee approvals.
The views expressed in this study are those of the authors and not necessarily those of the funding bodies.