Unequal progress: Socioeconomic and age disparities in UK cardiovascular disease trends
A comprehensive study published in The BMJ [1] reveals a complex picture of cardiovascular disease (CVD) trends in the UK over the past two decades. While rates of coronary heart disease have declined significantly, this progress has been offset by rising incidences of other cardiovascular conditions.
Researchers analysed data from over 1.6 million individuals with newly diagnosed CVD between 2000 and 2019. The study encompassed ten common cardiovascular diseases, including acute coronary syndrome, aortic aneurysm, atrial fibrillation, heart failure, and stroke.
The findings indicate a 19% overall decline in rates across all ten CVDs during the study period. Notably, coronary heart disease and stroke saw substantial reductions of approximately 30%. However, these improvements were offset by increasing diagnoses of arrhythmias, valve diseases, and thromboembolic conditions.
Age and socioeconomic disparities
A closer examination of the data revealed significant disparities in cardiovascular health improvements across different age groups and socioeconomic strata. The researchers note that “the decline in coronary heart disease was largely restricted to age groups older than 60 years, with little or no improvement in younger age groups”.
Moreover, a persistent socioeconomic gradient was observed for almost every CVD investigated. The most deprived groups consistently exhibited higher CVD rates compared to the least deprived. This disparity was particularly pronounced for peripheral artery disease, with rates nearly twice as high in the most socioeconomically disadvantaged cohort. Acute coronary syndrome and heart failure also showed markedly higher rates (approximately 50%) in the most deprived group.
Geographical variations
The study identified higher rates of all ten cardiovascular conditions in northern regions of England (North West, North East, Yorkshire and The Humber) compared to London, even after adjusting for socioeconomic status. However, the authors note that these geographical variations remained relatively modest and did not appear to change substantially over the study period.
Implications for future prevention strategies
Despite the overall decline in atherosclerotic diseases, the researchers emphasise that “the overall burden of CVDs remained high during 2000-19.” This finding underscores the need for a more comprehensive approach to cardiovascular health in the UK.
The authors conclude: “For CVDs to decrease further, future prevention strategies might need to consider a broader spectrum of conditions, including arrhythmias, valve diseases, and thromboembolism, and examine the specific needs of younger age groups and socioeconomically deprived populations.”
Study limitations
While this observational study provides valuable insights, the authors acknowledge several limitations. These include potential constraints of health record data, the absence of additional variables relevant to CVD development, and limited ethnic diversity in the study population. Nevertheless, the large, representative sample size and consistent results after further analyses lend credibility to the findings.
This research underscores the need for tailored interventions that address the changing situation CVDs and target populations that have not benefited equally from current prevention strategies.
Reference:
- Conrad, N., Molenberghs, G., Verbeke, G., al. (2024). Temporal trends and patterns in incidence of cardiovascular disease among 22 million people in the UK: population based study. The BMJ. https://doi.org/10.1136/bmj-2023-078523
