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Smoking and poverty explain CHD variability

Most variation in cardiac mortality in England is down to population characteristics

Louise Prime

Wednesday, 10 November 2010

The wide variation seen in coronary heart disease mortality across England is largely explained by population characteristics such as smoking and deprivation, shows research published in this week’s JAMA. Detection of hypertension also had a significant impact.

Louis Levene from the University of Leicester and colleagues investigated the factors leading to the wide variation in CHD mortality across England, despite universal free healthcare.

They gathered data on CHD mortality and population characteristics from all 152 PCTs in England – a total registered population of 54.3 million people in 2008. Population data included an index of multiple deprivation (low measures on economic, social and housing issues), as well as smoking, ethnicity and diabetes.

They also collected data on service characteristics (level of provision of primary care services, levels of detected hypertension, pay for performance data). Overall, the average age-standardised CHD mortality rates decreased from 97.9 per 100,000 European Standard Population in 2006, to 93.5 per 100,000 in 2007 and to 88.4 in 2008.

The authors found that four population characteristics were significantly positively associated with CHD mortality: index of multiple deprivation, smoking, white ethnicity, and registers of individuals with diabetes. The level of detected hypertension was the only service characteristic that was significantly negatively associated with CHD mortality.

The authors write: “Higher proportions of white individuals, higher levels of deprivation, higher levels of diabetes, higher proportions of smokers, and lower levels of detected hypertension were associated with higher levels of CHD mortality at PCT level in our models.”

They conclude: “These findings have a number of implications. Coronary heart disease mortality rates are predominantly explained by population characteristics. Programmes to reduce mortality should address those characteristics of populations amenable to intervention, including smoking and deprivation.

“The importance of paying attention to population characteristics is emphasised by the finding that better detection of hypertension in the population was associated with reduced CHD mortality at the population level.”

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