Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study

doi:10.1136/bmj.b2613

Published 14 July 2009, doi:10.1136/bmj.b2613
Cite this as: BMJ 2009;339:b2613

Research

Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study

Martin O’Flaherty, MRC research fellow¹, Jennifer Bishop, programme principal ScotPHO ², Adam Redpath, programme principal for CHD and stroke programme², Terry McLaughlin, senior information analyst², David Murphy, senior information analyst², James Chalmers, consultant in public health², Simon Capewell, professor of clinical epidemiology¹

¹ Division of Public Health, University of Liverpool, Liverpool L69 3GB, ² ISD Scotland, Edinburgh EH12 9ED

Correspondence to: S Capewell capewell{at}liverpool.ac.uk

Objective To examine recent trends and social inequalities inage specific coronary heart disease mortality.

Design Time trend analysis using joinpoint regression.

Setting Scotland, 1986-2006.

Participants Men and women aged 35 years and over.

Main outcome measures Age adjusted and age, sex, and deprivationspecific coronary heart disease mortality.

Results Persistent sixfold social differentials in coronaryheart disease mortality were seen between the most deprivedand the most affluent groups aged 35-44 years. These differentialsdiminished with increasing age but equalised only above 85 years.Between 1986 and 2006, overall, age adjusted coronary heartdisease mortality decreased by 61% in men and by 56% in women.Among middle aged and older adults, mortality continued to decreasefairly steadily throughout the period. However, coronary heartdisease mortality levelled from 1994 onwards among young menand women aged 35-44 years. Rates in men and women aged 45-54showed similar flattening from about 2003. Rates in women aged55-64 may also now be flattening. The flattening of coronaryheart disease mortality in younger men and women was confinedto the two most deprived fifths.

Conclusions Premature death from coronary heart disease remainsa major contributor to social inequalities. Furthermore, theflattening of the decline in mortality for coronary heart diseaseamong younger adults may represent an early warning sign. Theobserved trends were confined to the most deprived groups. Markeddeterioration in medical management of coronary heart diseaseseems implausible. Unfavourable trends in the major risk factorsfor coronary heart disease (smoking and poor diet) thus providethe most likely explanation for these inequalities.

© O et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant Articles

Fall in deaths from heart disease may be ending as Canada sees a rise in prevalence: David Spurgeon
BMJ 2009 339: b3001. [Extract] [Full Text]

Why has mortality from coronary heart disease in young adults levelled off?: Alastair H Leyland and John W Lynch
BMJ 2009 339: b2515. [Extract] [Full Text]

"I don't like Mondays" $---$ day of the week of coronary heart disease deaths in Scotland: study of routinely collected data: Christine Evans, James Chalmers, Simon Capewell, Adam Redpath, Alan Finlayson, James Boyd, Jill Pell, John McMurray, Kate Macintyre, and Lesley Graham
BMJ 2000 320: 218-219. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Leyland, A. H, Lynch, J. W (2009). Why has mortality from coronary heart disease in young adults levelled off?. BMJ 339: b2515-b2515 [Full text]

Rapid Responses:

Read all Rapid Responses

Ethnicity of socio-economic groups - key factor in assessing CAD: Pankaj Garg
bmj.com, 16 Jul 2009 [Full text]
Widening of Inequalities in CVD outcomes in women in Knowsley: David C Taylor-Robinson, et al.
bmj.com, 3 Aug 2009 [Full text]
Sixfold?: Peter G Sainsbury
bmj.com, 20 Jul 2009 [Full text]
Heart disease: not what you eat but what you don't eat.: Eddie Vos
bmj.com, 20 Jul 2009 [Full text]
Eradication of cardiovascular diseases?: Arnaud Chiolero
bmj.com, 21 Jul 2009 [Full text]
60.9% decline?: John Baldwin
bmj.com, 25 Jul 2009 [Full text]
Author's Reply: Martin O'Flaherty, et al.
bmj.com, 3 Aug 2009 [Full text]
Eradication of cardiovascular diseases?: Claire E Jackson-Prior
bmj.com, 4 Aug 2009 [Full text]
Re: Author's Reply: John Baldwin
bmj.com, 6 Aug 2009 [Full text]