Explaining trends in coronary heart disease mortality in different socioeconomic groups in Denmark 1991-2007 using the IMPACTSEC model

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Albert Marni Joensen, Torben Joergensen, Søren Lundbye-Christensen, Martin Berg Johansen, Maria Guzman-Castillo, Piotr Bandosz, Jesper Hallas, Eva Irene Bossano Prescott, Simon Capewell, Martin O'Flaherty

Aim
To quantify the contribution of changes in different risk factors population levels and treatment uptake on the decline in CHD mortality in Denmark from 1991 to 2007 in different socioeconomic groups.

Design
We used IMPACTSEC, a previously validated policy model using data from different population registries.

Participants
All adults aged 25–84 years living in Denmark in 1991 and 2007.

Main outcome measure
Deaths prevented or postponed (DPP).

Results
There were approximately 11,000 fewer CHD deaths in Denmark in 2007 than would be expected if the 1991 mortality rates had persisted. Higher mortality rates were observed in the lowest socioeconomic quintile. The highest absolute reduction in CHD mortality was seen in this group but the highest relative reduction was in the most affluent socioeconomic quintile. Overall, the IMPACTSEC model explained nearly two thirds of the decline in. Improved treatments accounted for approximately 25% with the least relative mortality reduction in the most deprived quintile. Risk factor improvements accounted for approximately 40% of the mortality decrease with similar gains across all socio-economic groups. The 36% gap in explaining all DPPs may reflect inaccurate data or risk factors not quantified in the current model.

Conclusions
According to the IMPACTSEC model, the largest contribution to the CHD mortality decline in Denmark from 1991 to 2007 was from improvements in risk factors, with similar gains across all socio-economic groups. However, we found a clear socioeconomic trend for the treatment contribution favouring the most affluent groups.
Original languageEnglish
Article numbere0194793
JournalPLoS ONE
Volume13
Issue number4
Number of pages13
ISSN1932-6203
DOIs
Publication statusPublished - 2018

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