The European Journal of Public Health Advance Access published online on October 16, 2008
The European Journal of Public Health, doi:10.1093/eurpub/ckn094
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Pace of change in coronary heart disease mortality in Finland, Ireland and the United Kingdom from 1985 to 2006
Tom O'Hara1, Kathleen Bennett1, Martin O'Flaherty2 and Siobhan Jennings3
1 Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
2 Division of Public Health, Whelan Building, Quadrangle, University of Liverpool, Liverpool L69 3GB, UK
3 Department of Public Health, Population Health Division, Health Services Executive, Dr Steevens’ Hospital, Dublin 8, Ireland
Correspondence: Dr Tom O’Hara, Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland, tel: 353 1 896 1565, fax: +35314539033, e-mail: tohara{at}tcd.ie
Received May 7, 2008 , accepted September 19, 2008
Background: Finland, Ireland and the United Kingdom have the highest rates of coronary heart disease (CHD) mortality among EU-15 countries. This study examines the pace of change in CHD mortality in these countries from 1985–2006. Methods: The percentage change in 5-year average all age, under 65 and 65 years and over age standardized mortality rates from 1985–89 to 2002–06 was calculated for each country. Joinpoint regression analysis was used to analyse age standardized mortality rates to identify points (years) where the slope of the linear trend changed significantly. The pace of change in the CHD mortality rate was measured using annual percentage change (APC). Results: The percentage change in 5-year age standardized (under 65) CHD mortality rates was similar in Finland and the UK for both genders whereas in Ireland the rate of change was greater, especially for females. The percentage change in 
65 year and all age rates was between 8.2% and 12.4% lower for Finnish males, and between 11.6% and 13% lower for Finnish females compared to their Irish and UK counterparts. There were different turning points in the downward trend in CHD mortality across the three countries varying from 1991–2003. The APC in CHD mortality after the turning point was greatest for Irish males (all age = –7.3%, under 65 = –8.2% and 65 and over = –7.1%), and Irish females (under 65 = –7.2%). Conclusion: We have identified differing pace of decline in three countries with similar burden of disease and successful national strategies to control CHD.
Keywords: coronary heart disease mortality, Finland, Ireland, pace of change, United Kingdom