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Trends in social inequalities for premature coronary heart disease mortality in Great Britain, 1994–2008: a time trend ecological study
  1. David McCartney1,2,
  2. Peter Scarborough1,
  3. Premila Webster1,
  4. Mike Rayner1
  1. 1Department of Public Health, University of Oxford, Oxford, UK
  2. 2Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr David McCartney; david.mccartney{at}


Objective To compare trends in metrics of socioeconomic inequalities in premature coronary heart disease (CHD) mortality in Great Britain.

Design Time trend ecological study with area-level deprivation as exposure.

Setting Great Britain, 1994–2008.

Participants Men and women aged younger than 75 years. No lower age limit.

Interventions None.

Main outcome measures CHD mortality rates.

Results There has been a decrease in socioeconomic inequalities in CHD mortality in absolute terms but an increase in relative terms. CHD mortality rates in men aged younger than 75 years fell by 69 per 100 000 (95% CIs 64 to 74) in the least deprived quintile and by 92 per 100 000 (95% CI 86 to 98) in the most deprived quintile (p for trend: <0.001). Mortality rate ratios comparing the most deprived quintile to the least deprived quintile increased in women aged younger than 75 years from 1.77 (95% CI 1.68 to 1.86) to 2.32 (95% CI 2.14 to 2.52). There was a weak negative association between the average decline of relative rates and area deprivation.

Conclusions It could either be said that inequalities in premature mortality from CHD between affluent and deprived areas have widened or narrowed between 1994 and 2008 depending on the measurement technique. In the context of falling CHD mortality rates, narrowing of absolute inequalities is to be expected, but increases in relative inequalities are a cause for concern.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: McCartney D, Scarborough P, Webster P, et al. Trends in social inequalities for premature coronary heart disease mortality in Great Britain, 1994–2008: a time trend ecological study. BMJ Open 2012;2:e000737. doi:10.1136/bmjopen-2011-000737

  • Contributors DM, PS, MR and PW conceived the study. DM and PS designed the analysis. DM analysed the data and produced the first draft of the manuscript. DM, PS, MR and PW commented on and approved the final manuscript.

  • Funding MR and PS are supported the by the British Heart Foundation programme grants (PPC/Jul05/5b and PPC/JAN05/6biii).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

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