O1-4.1 Explaining recent coronary heart disease mortality trends in England by socioeconomic circumstances, 2000-2007

Abstract

Introduction The continuing fall in coronary heart disease mortality rates is widely celebrated. However, the impact of public policies and treatments is poorly quantified and hardly ever by socioeconomic group. Methods Using a previously validated epidemiological model we estimated the contribution of risk factor changes and evidence-based treatments to reduce CHD mortality in adults aged over 25 years between 2000 and 2007 in England, both overall and by deprivation quintiles. Results CHD mortality rates fell by 35% (219 to 142 deaths per 100 000), resulting in 38 070 fewer deaths in 2007 compared with 2000. Decreases in major cardiovascular risk factors were generally modest accounting for −37% of the total decrease in CHD mortality overall. This ranged from −50% in the most deprived quintile to −30% in the most affluent. The biggest contribution came from a fall in systolic blood pressure (−33%). Other gains were modest: total plasma cholesterol (−6%), smoking (−4%) and inactivity (−2%). Furthermore, these benefits were negated by increases in BMI and diabetes (+11%). Treatments accounted for approximately half the mortality decline across all social groups. The largest contributors were medical therapies in community settings for lipid reduction (−14%), chronic angina (−13%) and secondary prevention (−11%). Conclusions Much of the fall in CHD mortality in England between 2000 and 2007 was attributable to medical therapies, evenly distributed across social groups. This was unexpected, and probably reflects frustratingly small recent decreases in major cardiovascular risk factors, compounded by continuing rises in obesity and diabetes.