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Recent UK trends in the unequal burden of coronary heart disease
  1. Jonathan Pearson-Stuttard1,
  2. Madhavi Bajekal2,
  3. Shaun Scholes2,
  4. Martin O'Flaherty3,
  5. Nathaniel Mark Hawkins4,
  6. Rosalind Raine2,
  7. Simon Capewell3
  1. 1Christ Church, University of Oxford, Oxford, UK
  2. 2Department of Applied Health Research, University College London, London, UK
  3. 3Division of Public Health & Policy, University of Liverpool, Liverpool, UK
  4. 4Institute of Cardiology Medicine & Science, Liverpool Heart and Chest Hospital, Liverpool, UK
  1. Correspondence to Jonathan Pearson-Stuttard, Medical Student, Christ Church, St Aldate's, Oxford, OX1 1DP, UK; jonathan.pearson-stuttard{at}chch.ox.ac.uk

Abstract

Introduction The burden of coronary heart disease (CHD) in the UK is substantial. However, recent trends and associated socioeconomic inequalities are not well studied. We aim to identify and analyse these trends stratified by age, gender and socioeconomic quintiles.

Methods We quantified the CHD burden and analysed trends from 1999 to 2007 in all adults aged over 25 years resident in England. Data sources included deaths (from ONS), health surveys, and hospital admissions (from Hospital Episode Statistics), all using ICD9 and ICD10 coding. Socioeconomic inequalities were calculated in both absolute and relative terms.

Results In 2007, the CHD burden comprised approximately 205 000 hospital admissions (acute and elective), including approximately 110 000 admissions with acute coronary syndrome. There were approximately 1.5 million CHD patients with chronic disease living in the community. Approximately 67 500 of these were admitted during 2007 for revascularisation. There were approximately 173 000 CHD patients living with heart failure, of whom some 14% required hospital admission during 2007. Between 1999 and 2007, age-specific hospital admission rates generally decreased by 20%–35%. Community prevalence decreased by 10%–20%. Strong socioeconomic gradients were apparent in all patient groups, persisting or worsening between 1999 and 2007.

Conclusions The burden of CHD is immense, costly and unequal. Hospital admissions attract more attention than the far more numerous patients living with chronic disease in the community. Population-based rates for hospital admissions and CHD prevalence have been declining by 3%–4% per annum. However, marked socioeconomic gradients have persisted or worsened—there is no room for complacency.

  • Socioeconomic inequalities
  • coronary
  • heart
  • disease burden
  • trends
  • quality of care and outcomes
  • epidemiology
  • heart failure
  • cardiac resynchronisation therapy
  • systolic heart failure
  • mortality statistics

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Footnotes

  • Funding MB and SS are honorary research staff at UCL, funded by Legal & General Assurance Society Limited (L&G) as part of its wider research collaboration with UCL on understanding the drivers of longevity. JPS, RR and SC are supported by the Higher Education Funding Council, and RR is partly funded by the National Institute for Health Research University College London Hospital/University College London Comprehensive Biomedical Research Centre. MOF is partly funded by the UK Medical Research Council and from European Community's Seventh Framework Programme (FP7/2007-–2013) under grant agreement no223075—the MedCHAMPS project and NH by the NHS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The IMPACTsec team had access to all data sources and has the responsibility for the contents of the report and the decision to submit for publication.

  • Competing interests None.

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

  • Data sharing statement Supplementary appendix (attached) available with open access from the corresponding author at jonathan.pearson-stuttard{at}chch.ox.ac.uk.

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