Scottish Longitudinal Study
Development & Support Unit
Social patterning of ischaemic heart disease in Scotland
Alastair Leyland (MRC Social and Public Health Sciences Unit, University of Glasgow)
Carolyn Davies (MRC Social and Public Health Sciences Unit, University of Glasgow)
Ruth Dundas (MRC Social and Public Health Sciences Unit, University of Glasgow)
Approved on 24-05-2010
Despite substantial declines, Ischaemic Heart Disease (IHD) remains the largest cause of death in Scotland and mortality rates are among the worst in Europe. There is evidence of strong, persisting regional and socioeconomic inequalities in IHD mortality, with the majority of such deaths being due to Acute Myocardial Infarction (AMI). The development of successful interventions will be enhanced by a better understanding of its social patterning.
The majority of work to date on health inequalities of IHD or AMI in Scotland has focused on area-level socioeconomic gradients in mortality [1,2], incidence , case fatality [4-7] and recurrence  from the disease. However, existing literature lack information on whether the effect of area-level socioeconomic status in such outcomes in Scotland is still of relative importance over and above the individual’s socioeconomic position. To date, our broader understanding of the patterning of IHD by individual socioeconomic status in Scotland has come from relatively small studies and has explored only mortality as an outcome .
In addition, the importance of pursuing individual-level socioeconomic status is reflected in the recommendation of the Expert Group on Measuring Health Inequalities that “rather than using area based measures of deprivation … linkage of individual records of health status with individual records of socio-economic status should be pursued” .
The SLS and linked hospital admissions data will be used to explore the relationship between ischaemic heart disease morbidity and mortality and individual-level (eg NS-SEC, education) and area-based (eg Carstairs scores, SIMD) socioeconomic factors. In particular, we are interested in exploring which socioeconomic factors (individual, area-level or a combination) explain the most variation in different acute myocardial infarction (AMI) outcomes; we will explore mortality, incidence, attack, case fatality and recurrence rates from the disease for the whole of Scotland and how inequalities in such rates have changed over time and differ by age, gender, social position and geographical region.
- Leyland AH et al (2007) Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study BMC Pub Health 7(172).
- O'Flaherty, M et al (2009) Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study British Medical Journal 339(b2613).
- Davies CA et al (2009) Increasing socioeconomic inequalities in first acute myocardial infarction in Scotland, 1990-92 and 2000-02 BMC Public Health 9(134).
- Capewell S et al (2000) Trends in case-fatality in 117 718 patients admitted with acute myocardial infarction in Scotland European Heart Journal, 21(22) 1833-1840.
- Capewell S (2006) Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: population-based cohort study Heart 92(11) 1563-1570.
- Juszczak E et al (1997) Measuring outcomes: One month survival after acute myocardial infarction in Scotland Heart 77(1) 88-88.
- Macintyre K (2001) Relation between socioeconomic deprivation and death from a first myocardial infarction in Scotland: population based analysis British Medical Journal 322(7295) 1152-1153.
- Davies CA, Leyland AH (2008) Trends and inequalities in acute myocardial infarction recurrence rates in Scotland, 1988-2003 European Journal of Public Health 18(S1) 116-117.
- Davey Smith G (1998) Individual social class, area based deprivation, cardiovascular disease risk factors and mortality: the Renfrew and Paisley study Journal of Epidemiology and Community Health 52 399-405.
- Scottish Government Health Analytical Services Division (2008) Long-term monitoring of health inequalities. First report on headline indicators - September 2008. Edinburgh: Scottish Government.
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