Background: This study investigates secular trends in ischaemic heart disease (IHD) and stroke mortality by socioeconomic status (SES) in Australia to determine if absolute and relative differences between low and high SES areas have changed over time.
Methods: IHD and stroke mortality data for adults aged 35–74 years and corresponding population data from Australian censuses for 1979–2006 were stratified into quintiles using an area-based measure of SES and analysed by quinquennia (and 2004–06). IHD and stroke (rates per 100,000) adjusted for age, country of birth, and rurality were compared across SES strata (separately by sex) using Poisson regression.
Results: Mortality declined monotonically over the study period in all SES groups and both sexes. Absolute differences between low and high SES groups narrowed for IHD in females (27 to 23 per 100,000) and stroke in males and females (16 to 13, and 13 to 7 per 100,000, respectively), although absolute differences widened for IHD in males (52 to 63 per 100,000). Relative declines were greater in high compared to low SES groups for IHD (28% average quinquennial decline in high SES; compared with 21% in low SES for males; 30% and 21% for females), and for stroke (25% average quinquennial decline in high SES; 21% in low SES for males; 26% and 23% for females).
Conclusion: Differences in mortality rates between lower and higher SES groups narrowed for both IHD (in females) and stroke (in males and females) from 1979–2006, indicating that the epidemic decline is now at a late stage when low SES groups are benefiting more, in absolute terms, than high SES groups. However males in the lower SES groups are still at an earlier stage of the epidemic decline in IHD mortality.
LeviFChatenoudLBertuccioPLucchiniFNegriELa VecchiaC. Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. Eur J Cardiovasc Prev Rehabil2009; 16(3): 333–350.
2.
MirzaeiMTruswellASTaylorRLeederSR. Coronary heart disease epidemics: not all the same. Heart2009; 95(9): 740–746.
3.
Al-RoomiKADobsonAJHallEHellerRFMagnusP. Declining mortality from ischemic heart disease and cerebrovascular disease in Australia. Am J Epidemiol1989; 129(3): 503–510.
4.
McElduffPDobsonAJamrozikKHobbsM. The WHO MONICA Study, Australia, 1984–93: A summary of the Newcastle and Perth MONICA Projects, AIHW cat. no. CVD 11; Cardiovascular Disease Series no. 13. Canberra: Australian Institute of Health and Welfare, 2000.
5.
TaylorRDobsonAMirzaeiM. Contribution of changes in risk factors to the decline of coronary heart disease mortality in Australia over three decades. Eur J Cardiovasc Prev Rehabil2006; 13(5): 760–768.
6.
TaylorRLewisMPowlesJ. The Australian mortality decline: cause-specific mortality 1907–1990. Aust N Z J Public Health1998; 22(1): 37–44.
7.
TaylorRPageADanquahJ. The Australian epidemic of cardiovascular mortality 1935–2005: effects of period and birth cohort. J Epidemiol Community Health2011. doi:10.1136/jech.2010.109538 (Epublication ahead of print).
8.
KaplanGAKeilJE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation1993; 88(4, Part 1): 1973–1998.
9.
MarmotMGShipleyMJRoseG. Inequalities in death – specific explanations of a general pattern?Lancet1984; 323(8384): 1003–1006.
10.
BeardJREarnestAMorganGChanHSummerhayesRDunnTM. Socioeconomic disadvantage and acute coronary events: a spatiotemporal analysis. Epidemiology2008; 19(3): 485–492.
11.
BennettS. Socioeconomic inequalities in coronary heart disease and stroke mortality among Australian men, 1979–1993. Int J Epidemiol1996; 25(2): 266–275.
12.
DraperGTurrellGOldenburgB. Health inequalities in Australia: Mortality, Health Inequalities Monitoring series no. 1; AIHW cat. no. PHE 55. Canberra: Queensland University of Technology and the Australian Institute of Health and Welfare, 2004.
13.
TaylorRCheyTBaumanAWebsterI. Socio-economic, migrant and geographic differentials in coronary heart disease occurrence in New South Wales. Aust N Z J Public Health1999; 23(1): 20–26.
14.
GonzalezMAArtalejoFRCaleroJdR. Relationship between socioeconomic status and ischaemic heart disease in cohort and case-control studies: 1960–1993. Int J Epidemiol1998; 27(3): 350–358.
15.
FawcettJBlakelyT. Cancer is overtaking cardiovascular disease as the main driver of socioeconomic inequalities in mortality: New Zealand (1981–99). J Epidemiol Community Health2007; 61(1): 59–66.
16.
DiderichsenFHallqvistJ. Trends in occupational mortality among middle-aged men in Sweden 1961–1990. Int J Epidemiol1997; 26(4): 782–787.
17.
MackenbachJPBosVAndersenOCardanoMCostaGHardingS. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol2003; 32(5): 830–837.
18.
MarmotMGMcDowallME. Mortality decline and widening social inequalities. Lancet1986; 328(8501): 274–276.
19.
SteenlandKHuSWalkerJ. All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 US states, 1984–1997. Am J Public Health2004; 94(6): 1037–1042.
20.
Australian Institute of Health and Welfare. Cardiovascular disease in Australia, Canberra: Australian Institute of Health and Welfare, 2009.
21.
GrayLHardingSReidA. Evidence of divergence with duration of residence in circulatory disease mortality in migrants to Australia. Eur J Public Health2007; 17(6): 550–554.
22.
PageABeggSTaylorRLopezAD. Global comparative assessments of life expectancy: the impact of migration with reference to Australia. Bull World Health Organ2007; 85(6): 474–481.
23.
TaylorRPageAMorrellSHarrisonJCarterG. Social and psychiatric influences on urban-rural differentials in Australian suicide. Suicide Life Threat Behav2005; 35(3): 277–290.
24.
Australian Institute of Health and Welfare. Australia’s health 2008, AIHW cat. no. AUS 99. Canberra: Australian Institute of Health and Welfare, 2008.
25.
Department of Primary Industries and Energy, Department of Human Services and Health. Rural, remote and metropolitan areas classification, 1991 census edition. Canberra: Department of Primary Industries and Energy, Department of Human Services and Health, 1994.
26.
Australian Bureau of Statistics. 2001 Census of population and housing: Socio-economic indexes for areas, Information paper, cat. no. 2039.0. Canberra: Commonwealth of Australia, 2003.
27.
DuttonTTurrellGOldenburgB. Measuring socioeconomic position in population health monitoring and health research, Health Inequalities Monitoring series no. 3. Brisbane: Queensland University of Technology, 2005.
28.
SAS Institute. SAS: Statistical software, version 9.1.3. Cary, NC: SAS Institute, 2003.
29.
RobinsonW. Ecological correlations and the behavior of individuals. Am Sociol Rev1950; 15(3): 351–357.
30.
VosTBarkerBBeggSStanleyLLopezAD. Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. Int J Epidemiol2009; 38(2): 470–477.
31.
Australian Institute of Health and Welfare. Cardiovascular disease mortality: Trends at different ages, Cardiovascular series no. 31; AIHW cat. no. 47. Canberra: Australian Institute of Health and Welfare, 2010.
32.
FosterP. Inequalities in health: what health systems can and cannot do. J Health Serv Res Policy1996; 1(3): 179–182.
33.
MacintyreS. Prevention and the reduction of health inequalities. BMJ2000; 320(7246): 1399–1400.
34.
KapralMKWangHMamdaniMTuJV. Effect of socioeconomic status on treatment and mortality after stroke. Stroke2002; 33(1): 268–275.
35.
LynchJDavey SmithGHarperSBainbridgeK. Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches. J Epidemiol Community Health2006; 60(5): 436–441.
36.
TobiasMTaylorRYehL-CHuangKMannSSharpeN. Did it fall or was it pushed? The contribution of trends in established risk factors to the decline in premature coronary heart disease mortality in New Zealand. Aust N Z J Public Health2008; 32(2): 117–125.
37.
BennettS. Cardiovascular risk factors in Australia: trends in socioeconomic inequalities. J Epidemiol Community Health1995; 49(4): 363–372.
38.
NajmanJMTolooGSiskindV. Socioeconomic disadvantage and changes in health risk behaviours in Australia: 1989–90 to 2001. Bull World Health Organ2006; 84(12): 976–984.
39.
TurrellGStanleyLde LooperMOldenburgB. Health inequalities in Australia: Morbidity, health behaviours, risk factors and health service use, Health Inequalities Monitoring series no. 2; AIHW cat. no. PHE 72. Canberra: Queensland University of Technology and the Australian Institute of Health and Welfare, 2006.
40.
ColhounHMHemingwayHPoulterNR. Socio-economic status and blood pressure: an overview analysis. J Hum Hypertens1998; 12(2): 91–110.
41.
DraganoNBobakMWegeNPeaseyAVerdePKubinovaR. Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health2007; 7(1): 255–255.
42.
PanagiotakosDBPitsavosCManiosYPolychronopoulosEChrysohoouCAStefanadisC. Socio-economic status in relation to risk factors associated with cardiovascular disease, in healthy individuals from the ATTICA study. Eur J Cardiovasc Prev Rehabil2005; 12(1): 68–74.
43.
SundquistJMalmstromMJohanssonSE. Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Int J Epidemiol1999; 28(5): 841–845.
44.
TyrolerHA. The influence of socioeconomic factors on cardiovascular disease risk factor development. Prev Med1999; 29: S36–S40.
45.
MainCThomasSOgilvieDStirkLPetticrewMWhiteheadM. Population tobacco control interventions and their effects on social inequalities in smoking: placing an equity lens on exisiting systematic reviews. BMC Public Health2008; 8(178)): doi: 10.1186/1471-2458-8-178.
46.
NiederdeppeJKuangXCrockBSkeltonA. Media campaigns to promote smoking cessation among socioeconomically disadvantaged populations: what do we know, what do we need to learn, and what should we do now?Soc Sci Med2008; 67(9): 1343–1355.
