The changing regional pattern of ischaemic heart disease mortality in southern Europe: still healthy but uneven progress.

AIMS: To describe the evolving regional pattern of mortality from ischaemic heart disease (IHD) in five countries in southern Europe. METHODS: We analyse the changing pattern of IHD mortality among men and women aged 30-74 years in the standard regions of France, Greece, Italy, Portugal and Spain between 1994 and 2001 using routine data. RESULTS: Greece and, to some degree, Spain saw little improvement in IHD mortality in the second half of the 1990s. By contrast, IHD mortality among Portuguese women more than halved during this period. However, in some countries national declines in mortality masked increased regional variation in IHD mortality in some populations (Greece, women). Other countries such as Italy became increasingly homogeneous. CONCLUSION: Our analyses of the available mortality data show that not only are there differences in IHD mortality between and within the countries of this region, but that these are changing relatively rapidly. A combination of changes in lifestyle and in the delivery of health care could be responsible for this changing situation. Some countries have achieved less than might be expected based on common assumptions about healthy lifestyles and there is a danger of complacency. Other countries need to increase efforts to ensure that achievements in reducing IHD mortality are enjoyed by all.