Deprivation

Deprivation, as measured by the Scottish Index of Multiple Deprivation, is associated with higher rates of CHD mortality. The relationship is stronger amongst the under 65s. ISD Scotland's Deprivation and Health in Scotland , published in 1998, discusses the impact of deprivation on CHD.

More recent figures on the effect of deprivation on mortality from CHD can be found in the health chapter of the Scottish Executive's Social Focus on Deprived Areas 2005.

Key points:

• Deprived populations have considerably higher levels of CHD mortality. The standardised mortality ratio (SMR) in the most deprived tenth of the population is almost five times higher than that in the least deprived tenth. (see Table DC1)

• There is a strong positive relationship between deprivation and CHD mortality rates. This relationship is evident for all ages but is strongest in the 0-64 age group.

• The relationship between operation rates and deprivation in any age/sex group does not reflect the strong relationship between CHD mortality and deprivation. Table DC2 shows the ratio between the actual number of interventions performed and the number expected. The expected number is calculated using national procedure rates, taking into account the age and sex composition of the population, and the level of disease as measured by the relative level of CHD mortality in each deprivation decile. The figures show fewer interventions performed than expected for the more deprived areas- a finding first reported in the CHD and Stroke Task Force Report . Since there is no evidence that less deprived patients are having inappropriate interventions, the findings indicate inequity of access to, uptake of, or supply of, interventions to more deprived populations. This inequality is more marked in males than in females.

CHD is one of the most significant causes of premature mortality in deprived communities. The 2007 Spending Review Target   is to reduce the standardised CHD mortality rate amongst the under 75s in the most deprived areas.

• There has been a 27.4% decrease in the standardised CHD mortality rate amongst the under 75s in the most deprived areas in Scotland between 2000 and 2006.
  
  
• Most health boards show a similar decline between the periods 1998-2000 and 2004-2006. Information for health boards is based on three year time periods due to the small numbers of annual deaths that occur in people aged under 75 in some areas.
  

Analysis	Date Last Updated	Excel available	Size	National Statistics
Table DC1 Coronary Heart Disease - Standardised mortality ratios by 2006 SIMD deprivation decile (2002-2006)	30 October 2007		101KB	√
Table DC2 Mortality Adjusted Operation Ratios for CABG, Angioplasties and CABG & Angioplasties, for year ending 31st March 2007; by SIMD 2006 deprivation decile, age and sex	30 October 2007		184KB	√
Table DC3 Trends (2002-2006) in mortality rate from coronary heart disease among the under 75s in the 15% most deprived SIMD2006 areas	29 April 2008		30KB	x
Table DC4 Number of deaths and European age sex standardised rates by NHS board; ages under 75; 15% most deprived SIMD2006	29 April 2008		55KB	x