In Scotland, young men and women (ages 35-44) from socially deprived groups are around six times more likely to die from heart disease than the most affluent individuals in the same age range, according to research published on bmj.com today.
The results reveal that this disparity diminishes with age but only disappears for people who are 85 or over.
The number of people dying from heart disease in Scotland has halved in the last two decades but the country still has some of the highest deaths in Europe and globally, says the study.
And while the overall number of deaths from heart disease in Scotland is decreasing, this decline is slowing down in young adults, especially those from deprived groups, say the authors.
The research team, led by Professor Simon Capewell, a clinical epidemiologist from the University of Liverpool, argue that the slow down is not due to poor treatment provision but is linked to unhealthy social environments and high risk behaviour like smoking and poor diet. They maintain that these factors are more common in individuals from deprived backgrounds and that this study reveals major social inequalities in Scotland.
The authors surveyed death rates from heart disease in Scotland from 1986 to 2006. The study included men and women aged 35 and over.
They conclude that: "These mortality changes reflect social gradients in unhealthy behaviour, lifestyle and circumstances resulting in poor diet and high tobacco consumption leading to unfavourable levels of major coronary heart disease risk factors. These inequalities are persisting in spite of the widespread and constant health promotion and health prevention initiatives, which suggests substantial and continuing barriers to healthy changes."
In an accompanying editorial, Professor Alastair Leyland, from the Medical Research Council in Glasgow, agrees that it is extremely worrying that the slowing of improvements at younger ages is confined to the most deprived groups and asks why these young Scots are "not sharing in the benefits seen by others?"
Given health promotion programmes have had limited success, Leyland argues that perhaps it is time "to tackle the social inequalities themselves - unequal distribution of power, money, resources and life chances."