Director of Public Health Annual Report 2022: Preventing heart disease and stroke in Buckinghamshire

Our health is strongly influenced by the places we live, work, and learn. People that live in the most deprived areas of England are four times more likely to die early from cardiovascular disease (before the age of 75), compared with people that live in the least deprived areas.[70]

The link between deprivation and death from cardiovascular disease follows a gradient. As the level of deprivation increases the death rate from cardiovascular disease increases. The graph below shows that although premature mortality from cardiovascular disease in England decreased between 2001 and 2019, differences between more and less deprived groups persisted. In 2020, there was a marked increase in premature mortality from cardiovascular disease, with the steepest increases in the most deprived deciles widening the gap. When the population is split into tenths (deciles) by deprivation, the risk of early death from cardiovascular disease was higher with increasing deprivation consistently from 2001 to 2020.[71]

The health behaviours people adopt are influenced by a wide range of factors, including their social and economic circumstances and the environments in which they live. Health behaviours that reduce the risk of cardiovascular disease are often more common in less deprived areas and those that increase the risk are more common in more deprived areas.

Adults who live in more deprived areas or have lower paid or manual jobs are more likely to be smokers.

People living in less deprived areas have higher physical activity levels. In 2020, 73% of people living in the least deprived areas were active compared with 57% in the most deprived areas.[72]

National data show that in 2020/21 adults in routine/semi-routine occupations and people that were long-term unemployed/had never worked (managerial, administrative and professional occupations, e.g. chief executive, doctor, or journalist) were 19% less likely to be active (52%) compared with those in the most affluent employment groups (71%).

The likelihood of being overweight or obese is greatest in the most deprived areas. In 2019, 39% of women in England in the most deprived fifth of the population were obese, compared with 18% in the least deprived fifth. 30% of men in the most deprived quintile were obese compared with 22% in the least deprived.[73] This gap has increased since 2014.

Inequalities in overweight and obesity begin in childhood and more children in deprived areas are overweight and obese than those in the least deprived areas.

Between 2006/7 and 2020/21 the gap in the prevalence of obesity between children attending school in the most and least deprived areas of England has widened.[74]

The drivers of obesity are wide ranging and linked to the area we live in. For example, the availability of affordable and high-quality food is likely to influence what we eat and evidence from Scotland and England found that the density of outlets from four major fast-food chains was most concentrated more deprived areas.[75] There are many other features of the place we live that influence the risk of being overweight or obese, such as access to safe places to play, uncluttered clean pavement and access to green spaces.[76]

People living in more deprived areas have a greater risk of harmful drinking behaviours or being dependent on alcohol.[77]

National analysis shows that people living in the most deprived communities are 30% more likely to have high blood pressure.[78]

Living in a more deprived area of England is also associated with increasing risk of developing diabetes (both diagnosed and undiagnosed).[79] The Health Survey for England in 2016 showed that people in the most deprived fifth of the population were more than twice as likely to have a diagnosis of diabetes, compared with the least deprived (7% vs 3% with diabetes). People living in the most deprived fifth of areas were twice as likely to have diabetes that had not been diagnosed compared with the least deprived (2.2% vs 1.0%).

Atrial fibrillation is a heart rhythm disorder that is believed to cause 20% of strokes.[80] People living in more deprived areas of the UK are more likely to develop atrial fibrillation and more likely to die from it.[81]

Poorer quality jobs, poorer quality housing and poorer quality environments are linked to an increased risk of cardiovascular disease as highlighted in a previous section. These are often more common in more deprived areas and in people on low income.

Research has indicated that there may be inequalities in access to specialist care for people living in more deprived areas, including longer waiting times and poorer access to cardiac interventions and acute stroke care.[82] However, for some interventions in primary care, for example provision of NHS Health Checks (which detect some key cardiovascular disease risk factors) has been found to be higher in deprived areas.[83]