Cardiovascular inequalities in England: an analysis

This new report updates our previous report on health inequalities in cardiovascular disease (CVD) due to deprivation in England. You can also read our latest analysis that examines how these inequalities are even more extreme in the ten most and least deprived local authorities in England. 

Download the full report or read the summary of findings on this page.

• Download the full report (PDF, 1.7MB, 41 pages)
• Visit GitHub (opens in a new window) to access the code developed for the analysis presented in the report.
• View the charts on this page in table format.

This report was reviewed and published in January 2025. Please refer to our BHF England CVD Factsheet (PDF) for the latest health statistics. 

What’s on this page

• Overview
• What are health inequalities?
• Socioeconomic disparities that influence health
• The link between deprivation and cardiovascular risk factors
• How many people are affected by cardiovascular disease
• Deprivation and CVD mortality
• What needs to happen next

Overview

An estimated 6.4 million people are living with cardiovascular diseases in England today. Millions more have risk factors for these conditions, such as high blood pressure, raised cholesterol, obesity and type 2 diabetes. Cardiovascular diseases cause over a quarter (26%) of all deaths in England.¹

Cardiovascular health is closely linked to broader factors that influence overall health. These include:

• Income: a person's earnings and financial stability.
• Environment: a person's surroundings, including air quality and access to green spaces.
• Access to health services: whether a person can easily get medical assistance when needed.

What are health inequalities?

Health inequalities encompass differences in health status, healthcare, and health-related risks between different population groups that are unfair and avoidable.² They include:

• Health status: e.g. some people may have a shorter life expectancy than others.
• Healthcare: e.g. some people may find it harder to access healthcare services than others. 
• Health-related risks: e.g. some people may find it harder to access healthy foods than others.

Socioeconomic disparities that influence health

There are clear and consistent gaps between the most deprived and least deprived groups across the cardiovascular pathway in England. We can see this in:

• the prevalence of risk factors
• hospital admissions
• the management of healthcare
• health outcomes (especially premature mortality).

The link between deprivation and cardiovascular risk factors

Heart health is influenced by a range of modifiable risk factors. In England, around 70% of the cardiovascular disease burden can be attributed to modifiable risk factors, such as smoking and physical activity, and clinical risk factors like high blood pressure (hypertension) and obesity. 

How common these things are in a population can be shaped by access to healthcare, social care and the conditions of where people live.

Key CVD risk factors in England

• Hypertension: In England, age-standardised data showed a clear association between deprivation and hypertension prevalence, with more deprived areas showing a higher prevalence than less deprived areas.
• Smoking: Data from 2017 to 2023 showed that despite a decline in smoking, prevalence across all deprivation deciles, smoking prevalence is still significantly higher in more deprived areas than less deprived areas in England. 
• Obesity: More deprived areas in England have a higher proportion of adults with a body mass index (BMI) classified as obese. 
• Physical activity: Data for 2022/23 showed that only 54% of adults in the most deprived decile in England were physically active, compared to around 74% in the least deprived decile. 

Graph showing the prevalence of CVD risk factors by deprivation in England 

View the table data for this graph.

Graph showing the prevalence of hypertension by deprivation in England 

View the table data for this graph.

How many people are affected by cardiovascular disease

The analysis also explored the prevalence of CVD conditions by deprivation in England (i.e. how many people are diagnosed with these diseases in a particular area). 

This section utilised data from 2 data sources: the Quality and Outcomes Framework (QOF), and CVDPREVENT. These sources provide a mixture of crude and age-standardised prevalence data. The age-standardised data adjusts for age differences. 

In this summary, we show the age-standardised prevalence data from CVDPREVENT for the period of June 2024. For the crude prevalence data, please see the full report. 

We found that: 

• The most deprived quintile had a higher age-standardised prevalence of cardiovascular disease (8.5%) than the least deprived quintile (5.4%). This is a prevalence gap of 3.1 percentage points.
• The age-standardised prevalence of heart failure was 1.68%, compared to 1.03% in the least deprived quintile. This represents a prevalence gap of 0.65 percentage points.
• When age is taken into account, the prevalence of atrial fibrillation is almost identical across deprivation quintiles.

Graph showing the prevalence of CVD conditions by deprivation in England 

View the table data for this graph.

Deprivation and CVD mortality

CVD mortality is strongly associated with deprivation. Rates for both, all-age and premature (under-75) mortality, are consistently higher in the most deprived areas of England. 

In 2023, the all-age CVD mortality rate was 51% higher in the most deprived decile than in the least deprived decile (284.7 per 100,000 people, compared to 188.3 per 100,000 people). 

Data for 2023 showed that the premature rate of death from CVD in England was twice as high in the most deprived decile than it was in the least deprived decile (108.0 per 100,000 people, compared to 54.0 per 100,000 people). 

Graph showing CVD mortality rates by deprivation in England 

View the table data for this graph.

What needs to happen next

• We need government and other relevant organisations to put specific plans in place to address the inequalities in cardiovascular health in England.
• We need government to work with the right people to address the heart and circulatory health outcomes mentioned.
• We need responsible organisations to monitor how well these plans are working, especially in reducing differences in heart care. 

Footnotes

1. British Heart Foundation Statistics. (2024) Global Factsheet. 
2. This definition of health inequalities is based on similar definitions provided by organisations including: NHS England, The King’s Fund, Public Health Scotland and the World Health Organization.