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

BackgroundCardiovascular 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.MethodsFor 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.ResultsOver 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.ConclusionAge-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.

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Accumulated neighbourhood deprivation and coronary heart disease: a nationwide cohort study from Sweden

BMJ Open ◽

10.1136/bmjopen-2019-029248 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029248

Author(s):

Sara Larsson Lönn ◽

Olle Melander ◽

Casey Crump ◽

Kristina Sundquist

Keyword(s):

Coronary Heart Disease ◽

Cohort Study ◽

Heart Disease ◽

Single Point ◽

Neighbourhood Deprivation ◽

Age Cohorts ◽

Chd Risk ◽

History Of ◽

Highly Correlated ◽

Over Time

ObjectiveNeighbourhood deprivation is a recognised predictor of coronary heart disease (CHD). The overall aim was to investigate if accumulated exposure to neighbourhood deprivation resulted in higher odds of CHD.DesignThis is a longitudinal cohort study. Models based on repeated assessments of neighbourhood deprivation as well as single-point-in-time assessments were compared.SettingSweden.Participants3 140 657 Swedish men and women without a history of CHD and who had neighbourhood deprivation exposure data over the past 15 years.Primary outcome measuresCHD within 5 years’ follow-up.ResultsThe results suggested a gradient of stronger association with CHD risk by longer cumulative exposures to neighbourhood deprivation, particularly in the younger age cohorts. Neighbourhood deprivation was also highly correlated over time, especially in older age cohorts.ConclusionsThe effect of neighbourhood deprivation on CHD might depend on age. Accounting for individuals’ baseline age may therefore be important for understanding neighbourhood environmental effects on the development of CHD over time. However, because of high correlation of neighbourhood deprivation over time, single-point-in-time assessments may be adequate for CHD risk prediction especially in older adults.

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Mortality from cardiovascular disease in a cohort of Swedish seafarers

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-019-01486-5 ◽

2019 ◽

Vol 93 (3) ◽

pp. 345-353 ◽

Cited By ~ 1

Author(s):

Helena P. Eriksson ◽

Karl Forsell ◽

Eva Andersson

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cerebrovascular Disease ◽

Total Mortality ◽

Occupational Exposures ◽

Board Type ◽

Different Types ◽

Standardised Mortality Ratios ◽

Over Time

Abstract Purpose The aim of this study was to investigate whether Swedish seafarers have increased mortality from cardiovascular disease compared with the general population. Methods Register-based longitudinal cohort study of 85,169 Swedish seafarers where all subjects with a minimum of 30 days service registered in the Seafarers’ Register 1985–2013 were included. Mortality from coronary heart disease, cerebrovascular disease and total mortality for comparison were analysed by calculating standardised mortality ratios (SMRs), with 95% confidence intervals (CIs). Mortality was further analysed by gender, duty on board, type of vessel, and over time. Results There was no increase in either mortality from cardiovascular disease or total mortality for seafarers, who had worked solely on passenger ferries. Mortality from coronary heart disease and cerebrovascular disease was increased for male seafarers < 46 years old who had worked on different types of vessels, SMR 1.48 (95% CI 1.06–2.01) and SMR 1.93 (95% CI 1.16–3.02), respectively. Analysing the seafarers by duty showed significantly increased SMRs from coronary heart disease in males aged < 46 of the categories “deck crew” and “engine officer/crew (ever)”. The total mortality for seafarers who had worked on different types of vessels was increased; males SMR 1.05 (95% CI 1.02–1.09) and females SMR 1.17 (95% CI 1.04–1.30), but decreased over time. Conclusions No increased mortality on passenger ferries but younger male seafarers on different types of vessels had increased mortality from cardiovascular disease. Reduction of hazardous occupational exposures onboard is important, such as shift work, stress and noise.

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The Joy of Statistics

10.1093/oso/9780198833444.001.0001 ◽

2019 ◽

Cited By ~ 1

Author(s):

Steve Selvin

Keyword(s):

Coronary Heart Disease ◽

Short Stories ◽

Heart Disease ◽

Infant Mortality ◽

Statistical Methods ◽

Ethnic Differences ◽

Coronary Heart Disease Risk ◽

Disease Risk ◽

Mortality Rates ◽

Heart Disease Risk

The Joy of Statistics consists of a series of 42 “short stories,” each illustrating how elementary statistical methods are applied to data to produce insight and solutions to the questions data are collected to answer. The text contains brief histories of the evolution of statistical methods and a number of brief biographies of the most famous statisticians of the 20th century. Also throughout are a few statistical jokes, puzzles, and traditional stories. The level of the Joy of Statistics is elementary and explores a variety of statistical applications using graphs and plots, along with detailed and intuitive descriptions and occasionally using a bit of 10th grade mathematics. Examples of a few of the topics are gambling games such as roulette, blackjack, and lotteries as well as more serious subjects such as comparison of black/white infant mortality rates, coronary heart disease risk, and ethnic differences in Hodgkin’s disease. The statistical description of these methods and topics are accompanied by easy to understand explanations labeled “how it works.”

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Mortality and associated risk factors in diabetics

Acta Endocrinologica ◽

10.1530/acta.0.110s021 ◽

1985 ◽

Vol 110 (4_Suppl) ◽

pp. S21-S26 ◽

Cited By ~ 33

Author(s):

R. J. Jarrett ◽

M. J. Shipley

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Mortality Risk ◽

Mortality Rates ◽

Potential Risk Factors ◽

Diabetic Population ◽

Associated Risk Factors ◽

The Relationship

Summary. In 168 male diabetics aged 40-64 years participating in the Whitehall Study, ten-year age adjusted mortality rates were significantly higher than in non-diabetics for all causes, coronary heart disease, all cardiovascular disease and, in addition, causes other than cardiovascular. Mortality rates were not significantly related to known duration of the diabetes. The predictive effects of several major mortality risk factors were similar in diabetics and non-diabetics. Excess mortality rates in the diabetics could not be attributed to differences in levels of blood pressure or any other of the major risk factors measured. Key words: diabetics; mortality rates; risk factors; coronary heart disease. There are many studies documenting higher mortality rates - particularly from cardiovascular disease -in diabetics compared with age and sex matched diabetics from the same population (see Jarrett et al. (1982) for review). However, there is sparse information relating potential risk factors to subsequent mortality within a diabetic population, information which might help to explain the increased mortality risk and also suggest preventive therapeutic approaches. In the Whitehall Study, a number of established diabetics participated in the screening programme and data on mortality rates up to ten years after screening are available. We present here a comparison of diabetics and non-diabetics in terms of relative mortality rates and the influence of conventional risk factors as well as an analysis of the relationship between duration of diabetes and mortality risk.

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Decline of coronary heart disease mortality in The Netherlands from 1978 to 1985: contribution of medical care and changes over time in presence of major cardiovascular risk factors

Journal of Cardiovascular Risk ◽

10.1097/00043798-199606000-00002 ◽

1996 ◽

Vol 3 (3) ◽

pp. 271-276 ◽

Cited By ~ 37

Author(s):

Michiel L. Bots ◽

Diederick E. Grobbee

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

The Netherlands ◽

Cardiovascular Risk Factors ◽

Coronary Heart Disease Mortality ◽

Disease Mortality ◽

Changes Over Time ◽

Over Time

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Abstract P115: How Many Coronary Heart Disease Deaths In Poland In 2020 Might Be Prevented By Further Reductions In Population Risk Factor Levels?

Circulation ◽

10.1161/circ.129.suppl_1.p115 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Piotr Bandosz ◽

Maria Guzman-Castillo ◽

Simon Capewell ◽

Tomasz Zdrojewski ◽

Julia Critchley ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

Smoking Prevalence ◽

Mortality Rates ◽

Mortality Reduction ◽

Scenario Reduction ◽

Saturated Fats ◽

Changes In Risk

Background: Poland has experienced one of the most dramatic declines in coronary heart disease (CHD) mortality rates in recent decades. This decline reflects the use of evidence based treatments and, crucially, population wide changes in diet. Our aim is to explore the potential for further gains in Poland by achieving population wide reductions in smoking, dietary salt and saturated fat intake and physical inactivity levels. Methods: A validated and updated policy model was used to forecast potential decreases in CHD deaths by 2020 as consequence of lifestyle and dietary changes in the population. Data from the most recent Polish risk factor survey was used for the baseline (2011). We modeled two different policy scenarios regarding possible future changes in risk factors: A) conservative scenario: reduction of smoking prevalence and physically inactivity rates by 5% between 2011 and 2020, and reduction of dietary consumption of energy from saturated fats by 1% and of salt by 10%. B) ideal scenario: reduction of smoking and physically inactivity prevalence by 15%, and dietary reduction of energy from saturated fats by 3% and of salt by 30%. We also conducted extensive sensitivity analysis using different counterfactual scenarios of future mortality trends. Results: Baseline scenarios. By assuming continuing declines in mortality and no future improvements in risk factors the predicted number of CHD deaths in 2020 would be approximately 13,600 (9,838-18,184) while if mortality rates remain stable, the predicted number of deaths would approximate 22,200 (17,792-26,688). Conservative scenario. Assuming continuing declines in mortality, small changes in risk factors could result in approximately 1,500 (688-2,940) fewer deaths. This corresponds to a 11% mortality reduction. Under the ideal scenario, our model predicted some 4,600 (2,048-8,701) fewer deaths (a 34% mortality reduction). Reduction in smoking prevalence by 5% (conservative scenario) or 15% (ideal scenario) could result in mortality reductions of 4.5% and 13.8% respectively. Decreases in salt intake by 10% or 30% might reduce CHD deaths by 3.0% and 8.6% respectively. Replacing 1% or 3% of dietary saturated fats by poly-unsaturates could reduce CHD deaths by 2.6% or 7.7% Lowering the prevalence of physically inactive people by 5%-15% could decrease CHD deaths by 1.2%-3.7%. Conclusion: Small and eminently feasible population reductions in lifestyle related risk factors could substantially decrease future number of CHD deaths in Poland, thus consolidating the earlier gains.

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