title: Comparing the decline in coronary heart disease and stroke mortality in neighbouring countries with different healthcare systems.
abstract: OBJECTIVE
  To examine age and gender specific trends in coronary heart disease (CHD) and stroke mortality in two neighbouring countries, the Republic of Ireland (ROI) and Northern Ireland (NI).
  
  
  METHODS
  Epidemiological study of time trends in CHD and stroke mortality.
  
  
  METHODS
  The populations of the ROI and NI, 1985-2010.
  
  
  METHODS
  None.
  
  
  METHODS
  Directly age standardised CHD and stroke mortality rates were calculated and analysed using joinpoint regression to identify years where the slope of the linear trend changed significantly. This was performed separately for specific age groups (25-54, 55-64, 65-74 and 75-84 years) and by gender. Annual percentage change (APC) and 95% CIs are presented.
  
  
  RESULTS
  There was a striking similarity between the two countries, with percentage change between 1985 and 1989 and between 2006 and 2010 of 67% and 69% in CHD mortality, and 64% and 62% in stroke mortality for the ROI and NI, respectively. However, joinpoint analysis identified differences in the pace of change between the two countries. There was an accelerated pace of decline (negative APC) in mortality for both CHD and stroke in both countries from the mid-1990s (APC ROI -8% (95% CI -9.5 to 6.5) and NI -6.6% (-6.9 to -6.3)), but the accelerated decrease started later for CHD mortality in the ROI. In recent years, a levelling off in CHD mortality was observed in the 25-54 year age group in NI and in stroke mortality for men and women in the ROI.
  
  
  CONCLUSIONS
  While differences in the pace of change in mortality were observed at different time points, similar, substantial decreases in CHD and stroke mortality were achieved between 1985 and 1989 and between 2006 and 2010 in the ROI and NI despite important differences in health service structures. There is evidence of a levelling in mortality rates in some groups in recent years.
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland. bennettk@tcd.ie
authors.forename: K
authors.initials: K
authors.lastname: Bennett
authors.forename: J
authors.initials: J
authors.lastname: Hughes
authors.forename: S
authors.initials: S
authors.lastname: Jennings
authors.forename: F
authors.initials: F
authors.lastname: Kee
authors.forename: E
authors.initials: E
authors.lastname: Shelley
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D006291:Health Policy; D054625:Healthcare Disparities; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D017149:Private Sector; D017150:Public Sector; D012111:Residence Characteristics; D017678:Sex Distribution; D012737:Sex Factors; D013222:State Medicine; D020521:Stroke / Q000401:mortality*; D013997:Time Factors