Department of Clinical Sciences, Center for Primary Health Care Research, Lunds Universitet, Lund, Sweden.
J Epidemiol Community Health. 2018 Apr;72(4):314-318. doi: 10.1136/jech-2017-210105. Epub 2018 Jan 12.
Cardiovascular disease (CVD) is the main cause of death in most industrialised countries, including those in Europe. The mortality rates due to coronary heart disease (CHD), one of the most serious CVD conditions, have been decreasing in most European countries during the last decades. However, whether the trends over time in CHD mortality rates differ depending on neighbourhood deprivation has rarely been investigated.
For each year of the study period, 1988-2012, in Sweden, age-standardised mortality rates were calculated for three different types of neighbourhoods, characterised by a Neighbourhood Deprivation Index. Joinpoint regression was used to investigate potential changes in age-standardised mortality rates by neighbourhood deprivation and over time.
Over the study period, age-standardised mortality rates due to CHD were consistently the highest in the deprived neighbourhoods and the lowest in the affluent neighbourhoods. We observed a statistically significant overall decline, ranging from 67% to 59%, in the age-standardised CHD mortality rates for each level of neighbourhood deprivation. Furthermore, the decline for the affluent neighbourhoods was significantly higher compared with the decline in the deprived neighbourhoods.
Age-standardised CHD mortality rates decreased significantly in Sweden between 1988 and 2012. This decline was more pronounced in the affluent neighbourhoods, which indicates that the improvements in prevention and treatment of CHD have not benefited individuals residing in deprived neighbourhoods to an equal extent. Knowledge of time trends in CHD mortality by level of neighbourhood deprivation may help guide decision-makers in the development of appropriate healthcare policies for deprived neighbourhoods.
心血管疾病（CVD）是大多数工业化国家（包括欧洲国家）的主要死亡原因。在过去几十年中，大多数欧洲国家因冠心病（CHD）导致的死亡率呈下降趋势，冠心病是最严重的 CVD 之一。然而，CHD 死亡率的时间趋势是否因邻里贫困程度而异，这一问题很少被研究。
在瑞典，对于研究期间的每一年，即 1988-2012 年，根据邻里剥夺程度的 Neighborhood Deprivation Index 来计算三种不同类型的邻里的年龄标准化死亡率。采用 Joinpoint 回归来调查不同邻里贫困程度和时间变化对年龄标准化死亡率的潜在影响。
在研究期间，CHD 死亡率在贫困邻里一直是最高的，在富裕邻里则是最低的。我们观察到，每个邻里贫困程度水平的年龄标准化 CHD 死亡率都呈统计学意义的显著下降，范围从 67%到 59%。此外，与贫困邻里相比，富裕邻里的下降幅度明显更高。
1988 年至 2012 年间，瑞典的年龄标准化 CHD 死亡率显著下降。在富裕邻里的降幅更为显著，这表明在预防和治疗 CHD 方面的改进并没有使居住在贫困邻里的个体同等受益。了解 CHD 死亡率的时间趋势按邻里贫困程度划分，可能有助于指导决策者制定针对贫困邻里的适当医疗保健政策。
