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Variations in coronary mortality rates between English primary care trusts: observational study 1993-2010

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posted on 2019-06-20, 13:36 authored by L.S. Levene, R. Baker, K. Khunti, M. J. G. Bankart
Background In England, coronary heart disease (CHD) mortality has declined, but variations remain. Methods This study aimed to describe under 75-year CHD mortality variations across geographically defined populations. Regression slopes for mortality data as a function of time were calculated for all 151 English primary care trusts (PCTs), giving the change in the expected age adjusted rate for each extra year. Results Between 1993 and 2010, the mean age-standardized CHD mortality rate decreased from 107.76 to 35.12 per 100 000, but the coefficient of variation increased from 0.21 to 0.27. The slope of decline was significantly less after 2004 (β −4.91 for 1993–2003, −3.04 for 2004–2010). The proportion of smokers decreased by 24.6%. The estimated proportion of the population with controlled hypertension increased by 74.4% (2003–2010), but diabetes increased by 138% (1994–2010) and the proportion of obese people increased by 74.3% (1993–2010). There was a greater decline in CHD mortality in PCTs with greater deprivation and smoking (2006–2010). Conclusions Since 2004, there has not been a relative reduction of variations in CHD mortality. Appropriate strategies to improve early detection and effective management of risk factors are needed to lower overall CHD mortality further and to reduce persistent variations across England.

Funding

This work had no dedicated funding, but was supported by the Program of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Research and Care (CLARHC) in Leicestershire, Northamptonshire, and Rutland and CLAHRC East Midlands.

History

Citation

Journal of Public Health, 2016, 38 (4), pp. e455-e463

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences

Version

  • VoR (Version of Record)

Published in

Journal of Public Health

eissn

1741-3850

Copyright date

2015

Available date

2019-06-20

Publisher version

https://academic.oup.com/jpubhealth/article/38/4/e455/2966930

Language

en

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