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

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.