Cardiovascular diseases and health inequalities in Europe—a pressing public health challenge

Abstract

Cardiovascular diseases are a leading cause of mortality in Europe.Extensive research has elucidated risk factors and preventive strategies.Incidence of cardiovascular diseases have decreased in several developed countries over recent decades.However, progress has been disproportionally slow in disadvantaged groups as lowincome and immigrant populations.Four papers in this Series provide an overview of the cardiovascular disease inequalities across Europe and the association between cardiovascular disease and social disparities.[1][2][3][4] Hoejstrup et al. focus on Nordic countries, 1 where inequality in access to care persists despite universal healthcare.Patients with low socioeconomic position, mental illness, or immigrant status receive inadequate care, leading to poor outcomes.1 Despite the highly evolved healthcare systems of the Nordic countries, relative cardiovascular mortality risks remain between 1.6 and 2.1 for persons with a low level of education compared with the highly educated.The gap in life expectancy between highly educated men and those with a low level varies between 4.0 years in Sweden and 5.1 years in Finland (with a slightly lower disparity for women). 1 The persistence of inequality may be an example of the Nordic paradox, i.e., the introduction of the welfare state in the 1960s and 1970s improved overall mortality, but mortality rates remained high in lower socioeconomic classes.5 As interpreted by Hoejstrup et al., the persistent inequality in cardiovascular disease mortality may be explained by the higher prevalence of smoking, unhealthy diets, alcohol consumption, physical inactivity, and obesity in socially disadvantaged subgroups, but also by a complex interplay between genetics, childhood environment, material living conditions, social and psychological factors, and access to health care.1,5 Although attempts have been made to reduce health inequality, concrete actions remain limited.

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