Recent UK trends in the unequal burden of coronary heart disease

Introduction The burden of coronary heart disease (CHD) in the UK is substantial. However, recent trends and associated socioeconomic inequalities are not well studied. We aim to identify and analyse these trends stratified by age, gender and socioeconomic quintiles. Methods We quantified the CHD burden and analysed trends from 1999 to 2007 in all adults aged over 25 years resident in England. Data sources included deaths (from ONS), health surveys, and hospital admissions (from Hospital Episode Statistics), all using ICD9 and ICD10 coding. Socioeconomic inequalities were calculated in both absolute and relative terms. Results In 2007, the CHD burden comprised approximately 205 000 hospital admissions (acute and elective), including approximately 110 000 admissions with acute coronary syndrome. There were approximately 1.5 million CHD patients with chronic disease living in the community. Approximately 67 500 of these were admitted during 2007 for revascularisation. There were approximately 173 000 CHD patients living with heart failure, of whom some 14% required hospital admission during 2007. Between 1999 and 2007, age-specific hospital admission rates generally decreased by 20%-35%. Community prevalence decreased by 10%-20%. Strong socioeconomic gradients were apparent in all patient groups, persisting or worsening between 1999 and 2007. Conclusions The burden of CHD is immense, costly and unequal. Hospital admissions attract more attention than the far more numerous patients living with chronic disease in the community. Population-based rates for hospital admissions and CHD prevalence have been declining by 3%-4% per annum. However, marked socioeconomic gradients have persisted or worsened-there is no room for complacency.