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Date:
Premature Cardiovascular Disease Mortality and Health Inequalities in
Wiltshire
22 March 2012
Author:
John Goodall, Cardiac & Stroke Service Development, Public Health
Sponsoring
Director:
Maggie Rae, Corporate Director of Public Health and Public Protection
Title:
Purpose of Report
1. To inform the Commissioning Committee about the declining rate of premature
cardiovascular disease1 (CVD) mortality in Wiltshire, the implications for health inequalities, and
related Public Health programmes.
Premature CVD mortality rates and deprivation
2.
Premature mortality is defined as deaths occurring before the age of 75. Chart 1 shows
that premature deaths from CVD in Wiltshire have approximately halved in a decade.
Wiltshire’s rates are below those of the South West and England.
Chart 1: Trends in CVD Mortality Rates, 1998-2010. Directly standardised rates per 100,000.
Source: NCHOD.
3.
Although there has been considerable reduction in premature CVD mortality since
1998, the 2010 rate represents around 260 premature deaths from CVD in Wiltshire.
Furthermore, Chart 1 does not indicate the effect of deprivation. Chart 2, below, compares
1999 with 2009 for CVD premature mortality across quintiles. A fall in mortality rates is
observed across all deprivation quintiles. The percentage reductions in mortality rates are
statistically significant for each quintile. However, the percentage reduction of 39% in the most
deprived quintile is the smallest reduction. Notwithstanding the overall reduction in premature
CVD mortality over the decade, this may indicate a potentially widening relative gap in
premature mortality between the most and least deprived quintiles.
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CVD includes heart disease, stroke, diabetes and kidney disease, which affect the body in different
ways, but are linked by a common set of risk factors.
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Chart 2: CVD Under 75 Mortality in Wiltshire by local IMD 2010, 1999 vs. 2009. Directly
standardised rates per 100,000. Source: Dr Fosters PHM.
Health inequalities gap
4.
The potentially widening gap in health inequalities is investigated in Chart 3 below.
Chart 3 compares the relative gap in CVD premature mortality between the most and least
deprived quintiles in Wiltshire, against Wiltshire’s overall CVD premature mortality rate. The
chart shows an increase in the relative health gap from 45% in 1999 to 71% in 2009. This
indicates a widening of health inequalities between the most and least deprived quintiles.
Chart 3: Comparison of the relative gap in U75 mortality by most and least deprived quintiles
against Wiltshire U75 mortality directly standardised rate per 100,000.
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Explanation of the findings
5.
Research by Bajekal et al 2 estimated the contribution of risk factor changes and
evidence-based treatments to reduce Coronary Heart Disease (CHD) mortality in adults
aged over 25 years between 2000 and 2007 in England, both overall and by deprivation
quintiles. Bajekal attributed the fall in CHD mortality in England between 2000 and 2007 to:





Treatments - approximately 52%.
Risk factors – approximately 37%.
An increase in drug prescribing in the community, with no inequity in uptake.
More lives saved due to bigger reduction in risk factors in deprived rather than
affluent areas.
But these were partly offset by faster increases in diabetes and Body Mass Index in
deprived areas.
Bajekal’s report concluded that:
6.
Much of the fall in CHD mortality in England between 2000 and 2007 was attributable
to medical therapies, evenly distributed across social groups. This was unexpected,
and probably reflects frustratingly small recent decreases in major cardiovascular risk
factors, compounded by continuing rises in obesity and diabetes.
Implications for Wiltshire
7.
Although the annual rate of premature mortality from CVD in Wiltshire has halved in a
decade, the analysis above shows:


The burden of premature mortality from CVD remains greatest in the most deprived
quintile.
An increasing relative gap in CVD health inequalities between the most deprived
quintile and the Wiltshire average.
8.
Those findings, together with the national findings from Bajekal et al, indicate the
continuing need for targeted CVD prevention work in the most deprived areas in Wiltshire.
Public Health CVD-related programmes in Wiltshire
9.
A number of Public Health Programmes are underway in Wiltshire aimed at
preventing premature mortality from CVD. These include:

Health improvement campaigns:
o Active Health (physical activity on referral) programme.
o Adult and children weight management programmes.
o Healthy schools programme.
o Change 4 Life programme.
o Implementation of Wiltshire Alcohol strategy.
o Pharmacy health promotion campaigns.
o Generic health promotion campaigns.
2
Explaining recent coronary heart disease mortality trends in England by Socioeconomic
circumstances, 2000-2007, M Bajekal,* S Scholes, H Love, N Hawkins, M O’Flaherty, R Raine, S
Capewell. Health Care Evaluation Group, Dept of Epidemiology and Public Health, UCL, London, UK;
Pensions and Annuity Group, Legal and General plc, London, UK; School of Population, Community
and Behavioural Sciences, University of Liverpool, Liverpool, UK.
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

NHS Health Checks offered by GPs for all those aged 40-74 years, not already on a
CVD register.
Stop Smoking Service.
10.
Additionally, the following Public Health CVD-related programmes are targeted at
people living in deprived areas:




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Health trainer programme.
Early years healthy eating programme.
CVD outreach activity by pharmacies – delivered in partnership with Local
Pharmaceutical Committee.
CVD outreach-based model of ad hoc sessions at markets and other venues –
implemented via locality lead GPs and Public Health Lifestyles Team.
HMP Erlestoke has offered an NHS Health Check to new arrivals aged 40-74 since
March 2010.
Conclusions
11.
In conclusion:





The annual rate of premature mortality from CVD in Wiltshire has halved in a decade.
There is an increasing relative gap in CVD health inequalities between the most
deprived quintile and the Wiltshire average.
Public Health programmes are underway to address risk factors in the most deprived
areas in Wiltshire and thus reduce the health inequalities associated with premature
CVD mortality.
There is a continued focus on Public Health programmes in areas of deprivation that
can support reduction in health inequalities.
Public Health continues to work with GP localities and primary care to address health
inequalities in Wiltshire.
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