What is the clinical evidence from this study?

Study design: Cohort. Intervention: Area deprivation (most deprived group) vs. Least deprived group. Primary outcome: cardiac mortality (HR 1.27, 95% CI 1.15-1.39, p=< 0.000).

December 5, 2020Open Access

Impact of area deprivation on the cardiac mortality in the UK between1991 and 2010: evidence from a population-based longitudinal study

Q: What are the key findings of this study?

Living in the most deprived areas was associated with a significantly higher risk of cardiac mortality compared to the least deprived areas (HR 1.27; 95% CI 1.15-1.39; P<0.000).

Key Result

Living in the most deprived areas was associated with a significantly higher risk of cardiac mortality compared to the least deprived areas (HR 1.27; 95% CI 1.15-1.39; P<0.000).

Study Design

Type

Cohort (n=217,965)

Structured PICO

Does area deprivation increase the risk of cardiac mortality in UK adults?

Population

217,965 UK adults followed for a median of 10 years to evaluate the association between area-based socioeconomic deprivation and cardiac mortality.

Exposure

Area deprivation (measured by Carstairs deprivation scores)

Comparator

Least deprived group

Outcome

Cardiac mortality and all-cause mortalityhard clinical

Area deprivation is a strong predictor of long-term cardiac and all-cause mortality, with a significantly greater impact on women than men.

Main Result

Hazard Ratio: 1.27 (95% CI 1.15–1.39)

p-value: p=< 0.000

Abstract

AIMS: Evidence from longitudinal studies on the influence of area deprivation in cardiac mortality is limited. We aimed to examine the impact of area deprivation on cardiac mortality in a large representative Scottish population. We also examined differences between women and men. METHODS AND RESULTS: Retrospective analysis was performed by using linked data from Scottish Longitudinal Study from 1991 to 2010. The main exposure variable was socioeconomic status using the Carstairs deprivation scores, a composite score of area-level factors. Cox proportional-hazards models were constructed to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiac mortality and all-cause mortality associated with area-based deprivation. Subgroup analyses were stratified by sex. In a representative population of 217 965 UK adults, a total of 58 770 deaths occurred over a median of 10 years of follow-up period. The risk of cardiac mortality and all-cause mortality showed a consistent graded increased across the deprived groups. Compared to the least deprived group, the adjusted HR of cardiac mortality in the most deprived group was 1.27 (1.15-1.39, P < 0.000). There was strong evidence that women from more deprived areas had significantly higher cardiac death risk than those from the least deprived areas (HR 1.42, 95% CI 1.22-1.65), while this observation was not strong in men with same background. CONCLUSION: Our study demonstrated area deprivation was the strong predictor of long-term cardiac mortality and all-cause mortality. The inequalities were substantially greater in women from more deprived areas than men from the same background.