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. 2009 Jul 14:339:b2613.
doi: 10.1136/bmj.b2613.

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

Martin O'Flaherty  1 , Jennifer Bishop, Adam Redpath, Terry McLaughlin, David Murphy, James Chalmers, Simon Capewell
Affiliations

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

Martin O'Flaherty et al. BMJ. .

Erratum in

  • BMJ. 2009;339:b3318

Abstract

Objective: To examine recent trends and social inequalities in age 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 deprivation specific coronary heart disease mortality.

Results: Persistent sixfold social differentials in coronary heart disease mortality were seen between the most deprived and the most affluent groups aged 35-44 years. These differentials diminished with increasing age but equalised only above 85 years. Between 1986 and 2006, overall, age adjusted coronary heart disease mortality decreased by 61% in men and by 56% in women. Among middle aged and older adults, mortality continued to decrease fairly steadily throughout the period. However, coronary heart disease mortality levelled from 1994 onwards among young men and women aged 35-44 years. Rates in men and women aged 45-54 showed similar flattening from about 2003. Rates in women aged 55-64 may also now be flattening. The flattening of coronary heart disease mortality in younger men and women was confined to the two most deprived fifths.

Conclusions: Premature death from coronary heart disease remains a major contributor to social inequalities. Furthermore, the flattening of the decline in mortality for coronary heart disease among younger adults may represent an early warning sign. The observed trends were confined to the most deprived groups. Marked deterioration in medical management of coronary heart disease seems implausible. Unfavourable trends in the major risk factors for coronary heart disease (smoking and poor diet) thus provide the most likely explanation for these inequalities.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Age standardised coronary heart disease mortality in Scotland by sex, 1986-2006
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Fig 2 Age specific coronary heart disease mortality trends in men and women (Scotland 1986-2006)
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Fig 3 Differences in coronary heart disease mortality trends by deprivation and sex, Scotland 1996-2006 (age standardised rates). SIMD=Scottish Index of Multiple Deprivation
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Fig 4 Coronary heart disease mortality trends by age and deprivation in men and women (Scotland 1996-2006). SIMD=Scottish Index of Multiple Deprivation
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Fig 5 Trends in coronary heart disease death deprivation rate ratios (European standardised), Scotland 1996-2006, both sexes. Reference category is third fifth
See this image and copyright information in PMC

Comment in

References

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