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Differences in declining mortality rates due to coronary heart disease by neighbourhood deprivation
  1. Daniel Oudin Åström,
  2. Jan Sundquist,
  3. Kristina Sundquist
  1. Department of Clinical Sciences, Center for Primary Health Care Research, Lunds Universitet, Lund, Sweden
  1. Correspondence to Dr Daniel Oudin Åström, Center for Primary Health Care Research, Department of Clinical Sciences Lunds Universitet, Lund 221 00, Sweden; daniel.oudin_astrom{at}


Background Cardiovascular disease (CVD) is the main cause of death in most industrialised countries, including those in Europe. The mortality rates due to coronary heart disease (CHD), one of the most serious CVD conditions, have been decreasing in most European countries during the last decades. However, whether the trends over time in CHD mortality rates differ depending on neighbourhood deprivation has rarely been investigated.

Methods For each year of the study period, 1988–2012, in Sweden, age-standardised mortality rates were calculated for three different types of neighbourhoods, characterised by a Neighbourhood Deprivation Index. Joinpoint regression was used to investigate potential changes in age-standardised mortality rates by neighbourhood deprivation and over time.

Results Over the study period, age-standardised mortality rates due to CHD were consistently the highest in the deprived neighbourhoods and the lowest in the affluent neighbourhoods. We observed a statistically significant overall decline, ranging from 67% to 59%, in the age-standardised CHD mortality rates for each level of neighbourhood deprivation. Furthermore, the decline for the affluent neighbourhoods was significantly higher compared with the decline in the deprived neighbourhoods.

Conclusion Age-standardised CHD mortality rates decreased significantly in Sweden between 1988 and 2012. This decline was more pronounced in the affluent neighbourhoods, which indicates that the improvements in prevention and treatment of CHD have not benefited individuals residing in deprived neighbourhoods to an equal extent. Knowledge of time trends in CHD mortality by level of neighbourhood deprivation may help guide decision-makers in the development of appropriate healthcare policies for deprived neighbourhoods.

  • coronary heart disease
  • health inequalities
  • neighborhood/place
  • social epidemiology

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  • Contributors DOÅ conceived and designed the study, collected, analysed and interpreted the data and wrote the first version of the manuscript. JS interpreted the data and critically revised the manuscript. KS was involved in the study design, interpreted the data and critically revised the manuscript.

  • Funding To KS from the Swedish Research Council and the National Heart, Lung and Blood Institute of the National Institutes of Health under award number R01HL116381. To JS and KS from ALF funding from Region Skåne.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.