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Heart disease and stroke deaths plummet in Scotland

Survival from stroke and heart attack is improving – but deprivation-related inequalities remain

Louise Prime

Wednesday, 30 January 2019

Cerebrovascular disease (CVD) mortality has plummeted by well over a third in Scotland over the past decade and incidence has also fallen by nearly an eighth, according to the latest official figures. Coronary heart disease (CHD) mortality has also dropped by more than a third – although the rate of decline has tapered off recently – and its incidence has declined by over a fifth. For CVD and CHD, 30-day mortality figures are also improving. But Scotland has a high prevalence of the risk factors for both CVD and CHD, and marked deprivation-related inequalities in mortality remain across the nation.

ISD Scotland has just published its latest annual data, covering the year to 31st March 2018, for CHD and for CVD, including stroke, subarachnoid haemorrhage and transient ischaemic attack (TIA). The CVD data reveal that the incidence rate for CVD decreased over the last decade by 12.1% – rates remained consistently higher in males than females – and the overall mortality rate for CVD decreased over the past decade by 38.7%. However, the mortality rate for CVD in the most deprived areas of Scotland was 36.0% higher than in the least deprived areas.

The percentage of people surviving for at least 30 days following their first emergency admission to hospital with a stroke improved over the past 10 years, from 80.8% in 2008-09 to 85.3% in 2017-18.

The data also reveal that even though the number of patients receiving prescriptions for drugs to treat diseases of the circulation increased by 11.2% in the past nine years, falls in medicines’ prices have meant that the cost of prescriptions dispensed for these drugs has fallen by 23.4% over the past nine years, to £135.7m in 2017-18.

ISD noted: “Despite a substantial decrease in rates of death over the last decade, there were 3,935 deaths in Scotland in 2017 where cerebrovascular disease, including stroke, is the underlying cause. Scotland has a high prevalence of the risk factors associated with cerebrovascular disease such as smoking and high blood pressure. Treating and preventing stroke is a national clinical priority for Scotland as outlined in the Stroke Improvement Plan.”

The picture for CHD was more mixed. The data showed a steady downward trend in deaths from CHD in Scotland, as the mortality rate fell by 35.5% between 2008 and 2017 – but the rate of decline has slowed in the past five years, with increases in 2015 for both sexes and in the males rate only for 2017. And although CHD incidence has fallen by 21.7% overall over the last decade, there was a small increase in age-standardised incidence rates among both males and females between 2016-17 and 2017-18.

Deprivation had a huge impact here, too. The standardised mortality ratio for CHD across all ages was 151.7 in the most deprived decile, compared with 65.2 in the least deprived; the difference was slightly less marked in the over-65 age group.

ISD also reported that since 2014 there appears to have been a flattening in the rate of decline in the incidence of heart attacks. There were small increases in rates in 2016 and 2017, with increases slightly higher in females than males.

However, the proportion of people who survived 30 days or more following their first heart attack improved over the period 2008-09 to 2017-18, from 88% to 93%.

ISD commented: “Despite a substantial reduction in the rate of death from CHD over the last decade, it remains one of the leading causes of death in Scotland. In 2017, there were 6,727 deaths in Scotland where CHD was the underlying cause… Scotland has a high prevalence of the risk factors associated with heart disease, such as smoking, poor diet and physical inactivity. Overall, it is estimated that around 6.4% of men and 4.0% of women are living with CHD.”

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