Background Substantial inequalities in age-standardised cardiovascular disease (CVD) mortality rates exist at the local authority (LA) level within England, with particular areas having consistently higher rates. Higher deprivation is associated with higher CVD mortality, but we know little about how the demographics and environments of LAs contribute to variations in mortality rates. Our aim was to explore the extent to which demographic, behavioural and environmental factors explain differences in all ages and premature CVD mortality between LAs in England.

Methods All data were sourced for each LA in England. Outcome variables were age-standardised 2012 to 2014 CVD mortality for all ages and those under 75 (premature mortality). Prevalence of ethnic and socioeconomic groups from the UK 2011 census, Public Health England data on index of multiple deprivation (IMD) score, prevalence of smoking, physical activity and obesity/overweight and Ordnance Survey environmental data on percentage of food shops, eating out shops, green/blue space, sporting facilities and health facilities were sourced. We used the Akaike Information Criterion (AIC) to assess which types of variables provided the best statistical model to explain variation in CVD mortality between LAs then used multiple linear regression to assess which variables remained associated with the outcome.

Results Including health, demographic, environment and IMD variables provided the best fit for explaining variation in CVD mortality at all ages, with an adjusted R2 of 0.63. For premature CVD mortality, excluding environmental data improved the fit of the model and gave an adjusted R2 of 0.82.

The percentage of Indian and Pakistani ethnic groups in LAs remained associated with all ages CVD mortality, along with higher scores for the employment domain and living environment domain of the IMD. For premature mortality, the percentage of Pakistani and Bangladeshi ethnic groups, excess weight prevalence and higher income and crime IMD scores remained associated.

Conclusion Certain IMD domains and prevalence of some South Asian ethnic groups are important for explaining variation in age-standardised cardiovascular disease mortality at the LA level in England. These findings are valuable for understanding which factors to target to reduce inequalities in CVD mortality between LAs in England.