title: Sizable variations in circulatory disease mortality by region and country of birth in six European countries.
abstract: BACKGROUND
  Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries.
  
  
  METHODS
  We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35-74 years old men and women.
  
  
  RESULTS
  South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37-1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05-1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64-0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries.
  
  
  CONCLUSIONS
  Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe's multiethnic populations.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Scotland, UK. S.B.Rafnsson@ed.ac.uk
authors.forename: Snorri B
authors.initials: SB
authors.lastname: Rafnsson
authors.forename: Raj S
authors.initials: RS
authors.lastname: Bhopal
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.forename: Anne
authors.initials: A
authors.lastname: Fagot-Campagna
authors.forename: Seeromanie
authors.initials: S
authors.lastname: Harding
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.forename: Ebba
authors.initials: E
authors.lastname: Hedlund
authors.forename: Knud
authors.initials: K
authors.lastname: Juel
authors.forename: Paola
authors.initials: P
authors.lastname: Primatesta
authors.forename: Michael
authors.initials: M
authors.lastname: Rosato
authors.forename: Gregoire
authors.initials: G
authors.lastname: Rey
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Wild
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: Irene
authors.initials: I
authors.lastname: Stirbu
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D044383:Black People; D002318:Cardiovascular Diseases / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality*; D003431:Cross-Cultural Comparison; D003718:Denmark / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012606:Scotland / Q000453:epidemiology; D020521:Stroke / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology; D014852:Wales / Q000453:epidemiology; D044465:White People