title: Trends and inequalities in cardiovascular disease mortality across 7932 English electoral wards, 1982-2006: Bayesian spatial analysis.
abstract: BACKGROUND
  Cardiovascular disease (CVD) mortality has more than halved in England since the 1980s, but there are few data on small-area trends. We estimated CVD mortality by ward in 5-year intervals between 1982 and 2006, and examined trends in relation to starting mortality, region and community deprivation.
  
  
  METHODS
  We analysed CVD death rates using a Bayesian spatial technique for all 7932 English electoral wards in consecutive 5-year intervals between 1982 and 2006, separately for men and women aged 30-64 years and ≥65 years.
  
  
  RESULTS
  Age-standardized CVD mortality declined in the majority of wards, but increased in 186 wards for women aged ≥65 years. The decline was larger where starting mortality had been higher. When grouped by deprivation quintile, absolute inequality between most- and least-deprived wards narrowed over time in those aged 30-64 years, but increased in older adults; relative inequalities worsened in all four age-sex groups. Wards with high CVD mortality in 2002-06 fell into two groups: those in and around large metropolitan cities in northern England that started with high mortality in 1982-86 and could not 'catch up', despite impressive declines, and those that started with average or low mortality in the 1980s but 'fell behind' because of small mortality reductions.
  
  
  CONCLUSIONS
  Improving population health and reducing health inequalities should be treated as related policy and measurement goals. Ongoing analysis of mortality by small area is essential to monitor local effects on health and health inequalities of the public health and healthcare systems.
authors.affiliation: Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, Imperial College London, London, UK.
authors.forename: Perviz
authors.initials: P
authors.lastname: Asaria
authors.forename: Lea
authors.initials: L
authors.lastname: Fortunato
authors.forename: Daniela
authors.initials: D
authors.lastname: Fecht
authors.forename: Ioanna
authors.initials: I
authors.lastname: Tzoulaki
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Abellan
authors.forename: Peter
authors.initials: P
authors.lastname: Hambly
authors.forename: Kees
authors.initials: K
authors.lastname: de Hoogh
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
mesh_terms: D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D006113:United Kingdom / Q000453:epidemiology