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. 2018 Apr;72(4):314-318.
doi: 10.1136/jech-2017-210105. Epub 2018 Jan 12.

Differences in declining mortality rates due to coronary heart disease by neighbourhood deprivation

Daniel Oudin Åström  1 , Jan Sundquist  1 , Kristina Sundquist  1
Affiliations

Differences in declining mortality rates due to coronary heart disease by neighbourhood deprivation

Daniel Oudin Åström et al. J Epidemiol Community Health. 2018 Apr.

Abstract

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.

Keywords: coronary heart disease; health inequalities; neighborhood/place; social epidemiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1.
Figure 1.
Development over time in mortality rates due to coronary heart disease by neighbourhood deprivation for the periods 1988–2002 and 2002–2012.
See this image and copyright information in PMC

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