Sizable variations in circulatory disease mortality by region and country of birth in six European countries

• Published in: European journal of public health 2013-08, Vol.23 (4), p.594-605
• Main Authors: Rafnsson, Snorri B, Bhopal, Raj S, Agyemang, Charles, Fagot-Campagna, Anne, Harding, Seeromanie, Hammar, Niklas, Hedlund, Ebba, Juel, Knud, Primatesta, Paola, Rosato, Michael, Rey, Gregoire, Wild, Sarah H, Mackenbach, Johan P, Stirbu, Irene, Kunst, Anton E
• Format: Article
• Language: English
• Subjects: Adult; African Continental Ancestry Group; Africans; Aged; Asian Continental Ancestry Group; Asians; Births; Cardiovascular Diseases - mortality; Cerebrovascular disease; Circulatory system; Coronary Disease - mortality; Country of birth; Cross-Cultural Comparison; Denmark; Denmark - epidemiology; Diseases; England; England - epidemiology; Equality; European Continental Ancestry Group; European Union; Female; France; France - epidemiology; Heart disease; Humans; Inequality; Male; Medicin och hälsovetenskap; Middle Aged; Migrants; Mortality; Mortality Rates; Netherlands; Netherlands - epidemiology; Popularity; Population; Public health; Reproductive health; Scotland; Scotland - epidemiology; Socioeconomic factors; Stroke - mortality; Sweden; Sweden - epidemiology; Wales; Wales - epidemiology; Women
• ISSN: 1101-1262; 1464-360X; 1464-360X
• DOI: 10.1093/eurpub/ckt023

Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35-74 years old men and women. South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37-1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05-1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64-0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe's multiethnic populations.