Background Coronary heart disease (CHD) deaths in the UK have plummeted since the 1970s. However, CHD remains the biggest single cause of premature mortality, particularly in deprived social groups. But have all social groups benefited equally from these declines? Or do the headline figures conceal differences in rates of decline among social strata, potentially generating conflicting views on inequalities? Our analysis therefore aimed to examine whether the rapid declines in overall CHD mortality have benefited all socio-economic groups, and explore the implications for future projections.
Methods We used a Bayesian analysis of an age-period-cohort model for the English population with data from Office for National Statistics (ONS). We projected age-specific CHD mortality by gender and deprivation status for the period 2007–2035, using 1982–2006 as the input. We converted the age-specific values to premature CHD death rates (ages 35–74). Deprivation status was measured by Index of Multiple Deprivation quintiles, which aggregate seven types of deprivation, including health and income. We first analysed the influence of the population-level trend in premature CHD mortality on absolute inequality, and second investigated the contributions to change in relative inequality. We quantified inequality by the variance in the probability of premature death among deprivation quintiles. Furthermore, we introduced a method to analyse the contribution of each group to the change in variance over time.
Results We found that overall mortality trends conceal heterogeneities. Our models predict more rapid declines in premature CHD death for the most affluent than for the most deprived quintiles (annualised rate of decline 2006–2025, 7.9% [95% CI 4.7–11.0%] versus 6.0% [1.9–10.0%] for men, and 6.3% [3.5–9.0%] versus 5.9% [2.2–9.5%] for women). Absolute inequality was projected to decrease by 87% (29–98%) among men and by 89% (48–98%) among women. This decrease was particularly driven by the most deprived groups, reflecting their higher premature death rates. However, relative inequality was projected to rise by 60% among men (26–107%) and by 10% (-15–42%) among women. Because premature death is declining more slowly in the most deprived, these increases are also mostly influenced by the most deprived.
Conclusion Overall, premature coronary death rates in England continue to decline steeply, regardless of deprivation status. Furthermore, absolute inequalities are decreasing, reflecting declines in the high premature mortality burden in deprived groups. However, relative inequalities are projected to widen further, reflecting slower mortality declines in the most deprived groups. We suggest that more aggressive and progressive prevention policies are urgently needed.
- coronary heart disease (CHD)
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