Policies needed to tackle inequalities in deaths from heart disease in England

Although improved treatment uptake for coronary heart disease in England has resulted in a dramatic fall in death rates over recent years, improvements in major risk factors vary substantially between richer and poorer people, according to a study by UK researchers in this week's PLoS Medicine.

The researchers, led by Madhavi Bajekal from University College London, examined trends in death rates from coronary heart disease in England between 2000 and 2007. They found that approximately half the fall in deaths was attributable to improved treatment uptake across all socioeconomic groups, which the authors say is consistent with equitable service delivery across the NHS. By contrast, opposing trends in major risk factors, which varied substantially by socioeconomic group, meant that their net contribution accounted for just a third of deaths averted.

In their analysis, the authors found that between 2000 and 2007, death rates from coronary heart disease fell from 229 to 147 deaths per 100,000—a decrease of 36%—and the contribution of medical treatments to the number of deaths prevented was very similar across all socioeconomic groups. However, although changes in risk factors were responsible for a larger proportion of deaths prevented in the most deprived people compared with the most affluent, the benefits of improvements in blood pressure, cholesterol, smoking, and physical activity were negated by rises in body mass index and diabetes in the most deprived groups.

According to the authors these findings show that whilst recent UK policies for salt reduction and tobacco control have been relatively effective, adverse trends in risk factors related to diet, including diabetes and BMI, continued unabated: rising fastest in the most disadvantaged groups. The authors therefore call for the further implementation of evidence-based policies to promote healthier diets.

Such policies must address the social gradient in these risk factors. Population-wide tobacco control policies in combination with targeted smoking cessation services are associated with greater percentage declines in smoking levels in deprived areas in England. Internationally, legislation, regulation, taxation, or subsidies have achieved substantial reductions in the saturated fat, trans-fats, sugars, and calories hidden in processed food, takeaways, and sweetened drinks.

The authors continue: "The UK now has a pressing need for population-wide policy interventions to effectively tackle persistent inequalities in cardiovascular mortality."