Long-term monitoring of health inequalities: March 2022 report

First ever hospital admission for heart attack aged under 75 years

Trends in heart attack hospital admissions

In 2020, just over 4,900 new cases of heart attack (for those aged under 75 years) were recorded in Scottish hospitals.

The rate of admissions decreased year on year from 145.1 per 100,000 at the start of the time series in 1997 to 80.4 per 100,000 in 2007, the lowest figure in the time series. While the rate of admissions in 2020 was 34% lower than in 1997 (95.4 compared to 145.1 per 100,000), it has increased by 19% since 2007.

Public Health Scotland’s (PHS) Scottish Heart Disease⁵ report notes that, overall, the incidence of coronary heart disease, which is based on first hospital admission or death, has been decreasing over the past ten years. The rate of decline had generally slowed in the last 4 years, although there was a sharper decline in 2020 which was likely due to the impact of the COVID-19 pandemic. It is therefore likely that the pandemic will have impacted the 2020 figures for this indicator, which monitors first hospital admissions for heart attacks.

Inequalities in heart attack hospital admissions, 2020

In 2020, the admission rate in Scotland’s most deprived areas was nearly twice that of those living in the least deprived (136.1 cases per 100,000 compared to 72.9 per 100,000).

Trends in relative inequalities

Relative inequality levels for heart attack hospital admissions have fluctuated over time, ranging from 0.69-1.01. The RII for 2020 (0.80) is slightly lower than that at the start of the time series (0.82).

Heart attack hospital admission rates (aged <75) have been 2-3 times higher in the most deprived areas compared to the least deprived areas across the time series.

Trends in absolute inequalities

The absolute gap in hospital admissions between those living in the most and least deprived areas was 63.2 per 100,000 in 2020, the lowest it has been since 2008 when the gap was 58.4 per 100,000.

The reduction in the gap between 2019 and 2020 has been driven by a 7% decrease in admission in the most deprived areas and an increase of 13% in the least deprived areas. The rate of admissions in the least deprived areas is the highest it has been since 2002.

Data from PHS’ COVID-19 wider impacts on the health care system dashboard⁶ reported that there was a sharp drop in A&E attendances for cardiovascular disease (which includes CHD, strokes, peripheral arterial disease and aortic disease) in early March 2020, with attendances around 60% lower compared to the 2018-2019 average. Attendance levels rose again by the end of May but remained approximately 30% below the 2018-2019 average. This drop was consistent across all deprivation areas, based on the Scottish Index of Multiple Deprivation (SIMD).

Although not directly comparable to the statistics in this indicator, which relate only to first hospital admissions for heart attacks, it does suggest that the COVID-19 pandemic may have influenced hospital admissions for heart attacks. The decrease in hospital admissions for those in the most deprived areas may therefore be a result of non-attendance at hospital as the result on the COVID-19 pandemic, rather than a real decrease in the rate of heart attacks.