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Declining cardiovascular mortality masks unpalatable inequalities
  1. Alastair H Leyland,
  2. Ruth Dundas
  1. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  1. Correspondence to Professor Alastair H Leyland, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G2 3AX, UK; alastair.leyland{at}

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Mortality from cardiovascular disease is declining in many European countries, but they remain socially patterned. Di Girolamo and colleagues investigate how inequalities in cardiovascular mortality have changed in 12 countries since the 1990s.1 In general, they appear cautiously optimistic, describing trends in such inequalities as ‘favourable overall’ while noting that further improvement is an important aspiration.

The paper raises an interesting (and old) question: which are more important, relative or absolute inequalities? The authors present both, which is good practice. It is not possible to summarise the distribution of mortality across social groups in a single number, no matter how much we might wish this to be the case. This fact is recognised by some policymakers; in Scotland, for example, the long-term monitoring of health inequalities2 includes publication of the relative index of inequality (detailing the magnitude of the inequality gradient), the absolute gap (the difference between groups at the extremes of the social spectrum) and the scale (indicating the magnitude of the problem).

To gauge the extent to which current trends should be regarded as favourable, we can examine future mortality. Di Girolamo et al provide the means to project cardiovascular disease mortality rates by occupational class (based on their Supplementary Tables S7 and S10). In table 1, we present various scenarios enabling us to look at potential future inequalities for upper non-manual employees and manual workers.

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Table 1

Projected scenarios for upper non-manual employees and manual …

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  • Twitter @AlastairLeyland

  • Contributors AL and RD collaborated on all stages and drafts of this editorial.

  • Funding Dr Leyland reports grants from Medical Research Council (MC_UU_12017/13), grants from Chief Scientist Office (SPHSU13) during the conduct of the study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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