Ten-year trends in all-cause mortality and coronary heart disease mortality in socio-economically diverse neighbourhoods

Abstract

Objective: Although all-cause mortality and coronary heart disease (CHD) mortality is declining in Sweden, as in most other countries in the industrialised world, we have limited information about the distribution and trends of mortality in deprived and affluent neighbourhoods.

Design: This study analyses the extent to which the decline in all-cause mortality and CHD mortality (over the age range 25-74 y) differs between affluent and deprived neighbourhoods during the decade 1984-1993. Incidence density ratios (IDR), estimated by Poisson regression, were calculated for small areas, grouped into population deciles, by both the care need index (CNI) and the Townsend deprivation score. On average, there were about 14 500 residents and 560 deaths in each decile over the period.

Setting: A large Swedish city.

Main outcome measures: All-cause mortality and mortality from CHD.

Results: The most deprived neighbourhoods had the highest IDR for all-cause mortality and CHD mortality. Over the period from 1984-1988 to 1989-1993 there was an overall decrease in all-cause mortality and CHD mortality, which was significantly higher in the most affluent areas. The mortality ratios for the most deprived neighbourhoods were almost three times higher than those of the most affluent areas.

Conclusions: People liviing in more affluent neighbourhoods have had the benefit of most of the last decade's decline in CHD mortality.