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  • 1.
    Di Girolamo, Chiara
    et al.
    University of Bologna, Bologna, Italy / Erasmus Medical Center, Rotterdam, Netherlands.
    Nusselder, Wilma J
    Erasmus Medical Center, Rotterdam, Netherlands.
    Bopp, Matthias
    University of Zurich, Zurich, Switzerland.
    Brønnum-Hansen, Henrik
    University of Copenhagen, Copenhagen, Denmark.
    Costa, Giuseppe
    University of Turin, Torino, Italy.
    Kovács, Katalin
    Demographic Research Institute, Budapest, Hungary.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallin, Estonia.
    Martikainen, Pekka
    University of Helsinki, Helsinki, Finland.
    Pacelli, Barbara
    Regional Health and Social Care Agency of Emilia-Romagna, Bologna, Italy.
    Rubio Valverde, José
    Erasmus Medical Center, Rotterdam, Netherlands.
    Mackenbach, Johan P
    Erasmus Medical Center, Rotterdam, Netherlands.
    Progress in reducing inequalities in cardiovascular disease mortality in Europe2020In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 106, p. 40-49Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe.

    METHODS: In this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the early 2010s in 12 European populations by gender, educational level and occupational class. In order to quantify changes in the magnitude of differences in mortality, we calculated both ratio measures of relative inequalities and difference measures of absolute inequalities.

    RESULTS: Cardiovascular mortality has declined rapidly among lower and higher socioeconomic groups. Relative declines (%) were faster among higher socioeconomic groups; absolute declines (deaths per 100 000 person-years) were almost uniformly larger among lower socioeconomic groups. Therefore, although relative inequalities increased over time, absolute inequalities often declined substantially on all measures used. Similar trends were seen for ischaemic heart disease and cerebrovascular disease mortality separately. Best performer was England and Wales, which combined large declines in cardiovascular mortality with large reductions in absolute inequalities and stability in relative inequalities in both genders. In the early 2010s, inequalities in cardiovascular mortality were smallest in Southern Europe, of intermediate magnitude in Northern and Western Europe and largest in Central-Eastern European and Baltic countries.

    CONCLUSIONS: Lower socioeconomic groups have experienced remarkable declines in cardiovascular mortality rates over the last 25 years, and trends in inequalities can be qualified as favourable overall. Nevertheless, further reducing inequalities remains an important challenge for European health systems and policies.

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