Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups

Seeromanie Harding ^1*, Michael Rosato ² and Alison Teyhan ¹

¹ MRC Social and Public Health Sciences Unit, United Kingdom
² Department of Epidemiology and Public Health, Queen's University Belfast, United Kingdom

^* To whom correspondence should be addressed. E-mail: seeromanie{at}sphsu.mrc.ac.uk.

Accepted 26 June 2007

Abstract

Objective: To examine trends in coronary heart disease and stroke mortality in migrants to England and Wales.

Design: Cross-sectional.

Outcome measures: Age and sex specific death rates, 1979-2003, of migrants and persons born in England and Wales (=1.00 in rate ratios), 30-69 years.

Results: Coronary and stroke mortality fell for all groups and, apart from female stroke mortality, fell faster in the second decade than the first. Coronary mortality remained higher for Scottish, Irish and South Asian men and women, and lower for Jamaican, other Caribbean, West African, Italian and Spanish men. For many groups, particularly Jamaicans, second decade declines were smaller than for England and Wales. In 1999-2003 Jamaican women had excess mortality for the first time (rate ratio 1.23, 95% CI 1.06-1.42). Increasing rate ratios were recorded for Bangladeshi (1979-83: 1.21, 1.18-1.24; 1999-2002: 2.34, 1.90-2.11), Polish (1979-83: 1.17,1.09-1.25; 1999-2002: 1.97,1.57-2.47) and Hungarian (1979-83: 0.98, 0.81-1.19; 1999-2002: 1.15,1.01-2.22) men and Pakistani women (1979-83: 1.14,0.88-1.47; 1999-2002: 2.45,2.19-2.74). Stroke mortality remained consistently higher for migrants. First decade declines for Jamaicans and Indian men were larger than for England and Wales. Smaller declines in Pakistani (1979-1983: 0.99, 0.76-1.29; 1999-2002: 1.58, 1.35-1.85) and Bangladeshi (1979-1983: 1.99, 1.45-2.74; 1999-2002: 3.12, 2.62-3.75) men led to increasing rate ratios.

Conclusion: Some migrant groups are losing relative protection against coronary deaths and relative stroke mortality remains excessive. There is a need for prevention and treatment programmes to maximise coverage across all groups, whilst recognising that minorities are no longer principally non-white.

Keywords: England and Wales, coronary heart disease, migrants, mortality trends, stroke

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