Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011.
OBJECTIVE
We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD), heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011.


METHODS
National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials.


RESULTS
Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels.
Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working-age population in low- and middle-income countries will likely experience increased cardiovascular-disease burden in terms of higher morbidity and mortality rates.
The Center for Global Health and Health Policy, Global Health and Education Projects, Riverdale, Maryland 20738, USA.
Gopal K
GK
Singh
University of Nebraska Medical Center, Department of Health Promotion, Social and Behavioral Health, Omaha, NE 68198-4365, USA.
Mohammad
M
Siahpush
The Center for Global Health and Health Policy, Global Health and Education Projects, Riverdale, Maryland 20738, USA.
Romuladus E
RE
Azuine
US Department of Health and Human Services, Rockville, Maryland 20857, USA.
Shanita D
SD
Williams
CVD mortality; Deprivation; Heart Disease; SES; Stroke; Work force