Coronary heart disease: Trends in spatial inequalities and implications for health care planning in England

The idea of health gain has recently received particular emphasis in health policy in England. One of the areas where there is considerable scope for health gain is in the reduction of mortality due to Coronary Heart Disease. Some reduction in mortality rates due to this cause have already been achieved in England in the 1980s. However, the change in standardised mortality rates varies around the country. A review of studies of geographies of declining CHD mortality shows that such geographical variation is typical of other countries which have recently experienced a reduction in the CHD epidemic. The paper presents the results of an analysis of change in spatial inequality in coronary heart disease mortality among the population aged 35-74 for the 190 District Health Authorities in England over the period 1982-1989. Data were derived from counts of cause-specific deaths and population estimates published by the Office of Population Censuses and Surveys. Various approaches were used to assess the change in spatial disparity which has accompanied the average overall reduction in mortality rates over the study period. The results show that the trends vary between age and sex groups in the population and that, particularly for older people, overall health gain across the country is being achieved at the cost of greater inequality in health between areas. The implications for local health strategies with respect to coronary heart disease reduction are discussed.