Per capita income and regional differences in ischemic heart disease (IHD) mortality trends between 1998 and 2007

Background: Recent studies revealed a significant decrease in mortality from IHD within Germany between 1998 and 2007. There are concerns that, particularly in younger subjects, low socioeconomic status (SES) may impede benefiting from improvements in cardiovascular treatment and prevention. We thus investigated whether IHD trends in German counties were influenced by their per capita income. Material and Methods: Data on deaths from IHD (ICD 10 I20-I25) between 1998 and 2007 and per capita income (1998) were obtained from the State Offices for Statistics. We categorised 429 German counties into quartiles of per capita income and calculated age-standardized mortality rates and mortality rate ratios (RR) to determine absolute and relative changes from 1998 to 2007. Results: In 1998, age-standardized mortality rates were higher in the quartile of counties with the lowest per capita income compared to the highest both for women (RR=1.58) and men (RR=1.46). In total, 90.7% of the lowest income-quartile consisted of counties from former Eastern Germany. A notable relative decline in mortality was observed for all quartiles between 1998 and 2007. However, counties with the lowest per capita income profited most (women 40.0%, men 39.1%).Thus, the gap between the lowest and the highest quartile markedly decreased for women (RR=1.58 to 1.46) and slightly for men (RR=1.46 to 1.42). Premature IHD mortality (20–64 years) also decreased in all quartiles, but revealed a growing gap between counties in the lowest and the highest quartile for men (RR=1.30 to 1.38). Discussion: This study indicates a convergence of IHD mortality rates between counties with low and high per capita income between 1998 and 2007, mainly due to a strong decrease within counties in former Eastern Germany. The increasing gap for younger men (20–64 years) indicates starting points for cardiovascular prevention and further research.