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Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s
  1. M Avendano1,*,
  2. A E Kunst1,
  3. M Huisman1,
  4. F V Lenthe1,
  5. M Bopp2,
  6. E Regidor3,
  7. M Glickman4,
  8. G Costa5,
  9. T Spadea5,
  10. P Deboosere6,
  11. C Borrell7,
  12. T Valkonen8,
  13. R Gisser9,
  14. J-K Borgan10,
  15. S Gadeyne6,
  16. J P Mackenbach1
  1. 1Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
  2. 2Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  3. 3Department of Preventive Medicine and Public Health, University of Madrid, Madrid, Spain
  4. 4Medical Statistics, Office for National Statistics, London, UK
  5. 5Department of Public Health and Microbiology, University of Turin, Turin, Italy
  6. 6Interface Demography, Free University Brussels, Brussels, Belgium
  7. 7Agencia de Salut Publica de Barcelona, Barcelona, Spain
  8. 8Department of Sociology, University of Helsinki, Helsinki, Finland
  9. 9Vienna Institute of Demography, Vienna, Austria
  10. 10Division for Health Statistics, Statistics Norway, Oslo, Norway
  1. Correspondence to:
    MrMauricio Avendano
    Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands; m.avendanopabon{at}


Objective: To assess the association between socioeconomic status and ischaemic heart disease (IHD) mortality in 10 western European populations during the 1990s.

Design: Longitudinal study.

Setting: 10 European populations (95 009 822 person years).

Methods: Longitudinal data on IHD mortality by educational level were obtained from registries in Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Age standardised rates and rate ratios (RRs) of IHD mortality by educational level were calculated by using Poisson regression.

Results: IHD mortality was higher in those with a lower socioeconomic status than in those with a higher socioeconomic status among men aged 30–59 (RR 1.55, 95% confidence interval (CI) 1.51 to 1.60) and 60 years and over (RR 1.22, 95% CI 1.21 to 1.24), and among women aged 30–59 (RR 2.13, 95% CI 1.98 to 2.29) and 60 years and over (RR 1.36, 95% CI 1.33 to 1.38). Socioeconomic disparities in IHD mortality were larger in the Scandinavian countries and England/Wales, of moderate size in Belgium, Switzerland, and Austria, and smaller in southern European populations among men and younger women (p < 0.0001). For elderly women the north–south gradient was smaller and there was less variation between populations. No socioeconomic disparities in IHD mortality existed among elderly men in southern Europe.

Conclusions: Socioeconomic disparities in IHD mortality were larger in northern than in southern European populations during the 1990s. This partly reflects the pattern of socioeconomic disparities in cardiovascular risk factors in Europe. Population wide strategies to reduce risk factor prevalence combined with interventions targeted at the lower socioeconomic groups can contribute to reduce IHD mortality in Europe.

  • ICD, International classification of diseases
  • IHD, ischaemic heart disease
  • RR, rate ratio
  • mortality
  • heart diseases
  • social class
  • Europe

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  • * Also the National Institute of Public Health and the Environment, Bilthoven, the Netherlands

  • Published Online First 10 October 2005

  • Funding sources had no role in the design, data collection, analysis, interpretation, or reporting of data, nor in the decision to submit the paper for publication. The authors of the paper are pleased to declare no competing interests. This study was based on existing data from census and mortality registries in Europe. Therefore, ethics approval was not necessary for the conduction of the study.