Abstract
AimTo quantify the contribution of changes in different risk factors population levels and treatment uptake on the decline in CHD mortality in Denmark from 1991 to 2007 in different socioeconomic groups.DesignWe used IMPACTSEC, a previously validated policy model using data from different population registries.ParticipantsAll adults aged 25–84 years living in Denmark in 1991 and 2007.Main outcome measureDeaths prevented or postponed (DPP).ResultsThere were approximately 11,000 fewer CHD deaths in Denmark in 2007 than would be expected if the 1991 mortality rates had persisted. Higher mortality rates were observed in the lowest socioeconomic quintile. The highest absolute reduction in CHD mortality was seen in this group but the highest relative reduction was in the most affluent socioeconomic quintile. Overall, the IMPACTSEC model explained nearly two thirds of the decline in. Improved treatments accounted for approximately 25% with the least relative mortality reduction in the most deprived quintile. Risk factor improvements accounted for approximately 40% of the mortality decrease with similar gains across all socio-economic groups. The 36% gap in explaining all DPPs may reflect inaccurate data or risk factors not quantified in the current model.ConclusionsAccording to the IMPACTSEC model, the largest contribution to the CHD mortality decline in Denmark from 1991 to 2007 was from improvements in risk factors, with similar gains across all socio-economic groups. However, we found a clear socioeconomic trend for the treatment contribution favouring the most affluent groups.
Highlights
Coronary heart disease (CHD) mortality has declined substantially during recent decades in Denmark and other Western countries [1]
The highest absolute reduction in CHD mortality was seen in this group but the highest relative reduction was in the most affluent socioeconomic
Explaining trends in coronary heart disease mortality in different socioeconomic groups in Denmark sent to Statistics Denmark: http://www.dst.dk/en/ OmDS/organisation/TelefonbogOrg.aspx? kontor=13&tlfbogsort=sektion or the Danish Data Protection Agency: https://www.datatilsynet.dk/ english/the-danish-data-protection-agency/ contact/
Summary
Coronary heart disease (CHD) mortality has declined substantially during recent decades in Denmark and other Western countries [1]. CHD, remains one of the leading causes of death, morbidity and economic burden for the Danish health care systems and in the world [2,3]. This decline has been attributable to decreases in prevalence of risk factors for CHD and to improvements of medical treatment and treatment uptake [4,5,6,7,8]. The most deprived groups have the highest reductions in CHD mortality in absolute numbers whereas the most affluent group benefit from the highest reductions in relative terms. Studies from UK have shown that inequality in health has significant economic costs due to loss of production, loss of tax payment and higher expenses to welfare and health care (https://heartuk.org. uk/files/uploads/Bridging_the_Gaps_Tackling_inequalities_in_cardiovascular_disease.pdf)
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