Progress in reducing inequalities in cardiovascular disease mortality in Europe

Abstract

ObjectiveTo assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe.MethodsIn this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the early 2010s in 12 European populations by gender, educational level and occupational class. In order to quantify changes in the magnitude of differences in mortality, we calculated both ratio measures of relative inequalities and difference measures of absolute inequalities.ResultsCardiovascular mortality has declined rapidly among lower and higher socioeconomic groups. Relative declines (%) were faster among higher socioeconomic groups; absolute declines (deaths per 100 000 person-years) were almost uniformly larger among lower socioeconomic groups. Therefore, although relative inequalities increased over time, absolute inequalities often declined substantially on all measures used. Similar trends were seen for ischaemic heart disease and cerebrovascular disease mortality separately. Best performer was England and Wales, which combined large declines in cardiovascular mortality with large reductions in absolute inequalities and stability in relative inequalities in both genders. In the early 2010s, inequalities in cardiovascular mortality were smallest in Southern Europe, of intermediate magnitude in Northern and Western Europe and largest in Central-Eastern European and Baltic countries.ConclusionsLower socioeconomic groups have experienced remarkable declines in cardiovascular mortality rates over the last 25 years, and trends in inequalities can be qualified as favourable overall. Nevertheless, further reducing inequalities remains an important challenge for European health systems and policies.

Impact of Gender Inequalities in the Causes of Mortality on the Competitiveness of OECD Countries

“…The perception of mortality inequalities is sensitive to the choice of method of differentiation, namely whether they are evaluated in absolute or relative terms [15,17]. In general, the development trend of mortality inequalities can be assessed as positive [18]. The development of mortality inequalities is influenced by many factors that have interactions in several areas of the social system, and therefore an examination of this issue in the economic dimension is essential.…”

Heartbeat: reducing inequities in cardiovascular disease mortality

“…Cardiovascular disease (CVD) remains a leading cause of death in Europe with persistent geographic and socioeconomic inequities even though overall CVD mortality has declined substantially over the past 30 years. In a prospective registry-based study of CVD mortality from the 1990s to early 2010s in 12 European populations, Girolamo and colleagues1 observed similar and rapid declines in absolute CVD mortality in both high and low socioeconomic groups. However, relative declines were faster among higher socioeconomic groups so that relative differences in CVD mortality have not been eliminated when considering gender, educational level, occupational class or geographic location (figure 1).…”

Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

“…In Lithuania, mortality due to IHD decreased by 14% in men and by 18% in women over the 10-year period [3]. However, an inequality in CVD mortality declines exists in Europe, with the largest differences between lower and higher socioeconomic groups observed in Central-Eastern European and Baltic countries [4].…”