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Contact: Sam Wong
sam.wong@imperial.ac.uk
44-207-594-2198
Imperial College London

Heart disease map of England highlights growing social inequality in older ages

A study estimating the death rate from heart and circulatory disease in each electoral ward in England has found that despite considerable improvements since the 1980s, the difference between the wealthiest and poorest communities has widened for people over 65.

Mortality from heart and circulatory disease the leading cause of death in the UK declined in most places between 1982 and 2006, but for men and women aged 65 or older, the decline was smaller in the most deprived communities, resulting in a wider gap between rich and poor.

The authors, from Imperial College London, warn that the declining trend in heart disease mortality could be threatened in some areas if the economic downturn and austerity measures affect poor communities disproportionately. Changes in the health system, such as the devolution of public health responsibilities to local authorities, might also put some communities at risk of falling behind, they suggest.

"It's clear that both social conditions and the quality of the health service strongly affect heart disease mortality," said study author Dr Perviz Asaria. "The Health and Social Care Act, which allows private companies to provide care under the NHS, and the extraordinary pressure on the NHS to make savings might jeopardise health services, including the crucial role of GPs, in poor communities. And if people's jobs are less stable, they may be forced to change their diet, or drink and smoke more. So we need to be concerned about these issues if we are going to carry on bringing death rates down.

"As public health gets taken up by local authorities, there's a danger that health budgets will have to compete with other services such as schools. It's essential that cardiovascular screening and prevention programmes don't get cut as a result."

The study is published today in the International Journal of Epidemiology. Heart disease mortality showed a strong correlation with the socioeconomic status of the ward, including income, employment and education levels. The correlation was strongest for young and middle-aged people up to age 65.

Broadly, the places with the highest death rates were in areas around Manchester and Liverpool, in parts of Yorkshire, around Birmingham and in deprived boroughs of London. Outside of London, death rates were generally low in southern England. Although heart and circulatory disease mortality fell from 1982 to 2006 in almost every area, it increased for women aged 65 or over in 186 out of 7932 wards.

Co-author Professor Majid Ezzati said: "These results are a valuable measure of the performance of the health system at a local level, which includes the NHS and public health services as well as other prevention strategies. We know how to reduce cardiovascular mortality: we have to reduce major risk factors like smoking, and provide good health services that help both with prevention through high-quality GP services and with treatment. We need to focus on putting these into practice in places that are behind."

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<< Data for each ward and maps are available to download see notes to editors. >>

The research, done at the Small-Area Health Statistics Unit (SAHSU) of the MRC-HPA Centre for Environment and Health at Imperial College London, was funded by the Wellcome Trust, the National Institute for Health Research (NIHR), and the NIHR Imperial Biomedical Research Centre. SAHSU also receives funding from the Health Protection Agency.

For further information please contact:

Sam Wong
Research Media Officer
Imperial College London
Email: sam.wong@imperial.ac.uk
Tel: +44(0)20 7594 2198

I will be on annual leave on Friday 2 November. On Friday, please contact:

Simon Levey
Research Media Officer
Imperial College London
Email: s.levey@imperial.ac.uk
Tel: +44(0)20 7594 2198

Out of hours duty press officer: +44(0)7803 886 248

Notes to editors

1. P Asaria et al. 'Trends and inequalities in cardiovascular disease mortality across 7932 English electoral wards, 1982: Bayesian spatial analysis.' International Journal of Epidemiology 2012;1 doi:10.1093/ije/dys151

2. About Imperial College London

Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.

Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve global health, tackle climate change, develop sustainable sources of energy and address security challenges.

In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.

Website: www.imperial.ac.uk

3. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.

4. The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. It supports the brightest minds in biomedical research and the medical humanities. The Trust's breadth of support includes public engagement, education and the application of research to improve health. It is independent of both political and commercial interests. www.wellcome.ac.uk



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