Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups.
OBJECTIVE
To examine trends in coronary heart disease and stroke mortality in migrants to England and Wales.


METHODS
Cross-sectional.


METHODS
Age-standardised and sex-specific death rates and rate ratios 1979-83, 1989-93 and 1999-2003.


RESULTS
Coronary mortality fell among migrants, more so in the second decade than the first. Rate ratios for coronary mortality remained higher for men and women from Scotland, Northern Ireland, Republic of Ireland and South Asia, and lower for men from Jamaica, other Caribbean countries, West Africa, Italy and Spain. Rate ratios increased for men from Jamaica (1979-83: 0.45, 0.40 to 0.50; 1999-2003: 0.81, 0.73 to 0.90), Pakistan (1979-83: 1.14, 1.04 to 1.25; 1999-2003: 1.93, 1.81 to 2.06), Bangladesh (1979-83: 1.36, 1.15 to 1.60; 1999-2003: 2.11, 1.90 to 2.34), Republic of Ireland (1979-1983: 1.18, 1.15 to 1.21; 1999-2003: 1.45, 1.39 to 1.52) and Poland (1979-83: 1.17, 1.09 to 1.25; 1999-2003: 1.97, 1.57 to 2.47), and for women from Jamaica (1979-83: 0.63, 0.52 to 0.77; 1999-2003: 1.23, 1.06 to 1.42) and Pakistan (1979-83: 1.14, 0.88 to 1.47; 1999-2003: 2.45, 2.19 to 2.74), owing to smaller declines in death rates than those born in England and Wales. Rate ratios for stroke mortality remained higher for migrants. As a result of smaller declines, rate ratios increased for men from Pakistan (1979-1983: 0.99, 0.76 to 1.29; 1999-2003: 1.58, 1.35 to 1.85), Scotland (1979-1983: 1.11, 1.04 to 1.19; 1999-2003: 1.30, 1.19 to 1.42) and Republic of Ireland (1979-1983: 1.27, 1.19 to 1.36; 1999-2003: 1.67, 1.52 to 1.84).


CONCLUSIONS
For groups with higher mortality than people born in England and Wales, mortality remained higher. Smaller declines led to increasing disparities for some groups and to excess coronary mortality for women from Jamaica. Maximising the coverage of prevention and treatment programmes is critical.
Harding
S
S
Medical Research Council, Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, Scotland G12 8RZ, UK. seeromanie@sphsu.mrc.ac.uk
Rosato
M
M
Teyhan
A
A
D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000208:ethnology / Q000401:mortality*; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005060:Europe / Q000208:ethnology; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012737:Sex Factors; D020521:Stroke / Q000208:ethnology / Q000401:mortality*; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D014852:Wales / Q000453:epidemiology
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12117828
BMJ. 2002 Mar 2;324(7336):511-6
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Soc Sci Med. 2003 Jan;56(2):355-61
12473320
Heart. 2003 Mar;89(3):276-9
12591830
Heart. 2003 Jun;89(6):681-6
12748237
Circulation. 2004 Mar 9;109(9):1101-7
14993137
Int J Epidemiol. 2004 Apr;33(2):382-6
15082645
Hypertension. 2004 May;43(5):1017-22
15037552
Atherosclerosis. 2004 Aug;175(2):295-303
15262186
BMJ. 2004 Aug 7;329(7461):318
15237088
Am J Public Health. 1997 Feb;87(2):160-8
9103091
BMJ. 1997 Mar 8;314(7082):705-10
9116545
Heart. 1997 Dec;78(6):555-63
9470870
Diabetes Care. 1999 Mar;22(3):434-40
10097925
BMJ. 1999 Jul 24;319(7204):215-20
10417082
Eur Heart J. 2006 Jan;27(1):107-13
16204263
BMC Public Health. 2005;5:125
16313671
Heart. 2006 Aug;92(8):1030-4
16387823
JAMA. 2007 Jan 17;297(3):286-94
17227980
J Public Health (Oxf). 2007 Jun;29(2):191-8
17456532
Circulation. 2000 Dec 19;102(25):3137-47
11120707
J Hypertens. 2001 Jan;19(1):41-6
11204303
BMJ. 2001 Feb 24;322(7284):466-7
11222422
Circulation. 2001 Dec 4;104(23):2855-64
11733407
Int J Food Sci Nutr. 2002 Sep;53(5):439-44
12396469