Heart of the matter: Cardiovascular inequalities in Northern Ireland

Historically, limited and inconsistent data have made it difficult to fully understand the burden of heart disease in Northern Ireland or the extent of inequalities in prevalence, risk factors and outcomes. Much of the research has relied on hospital admission and mortality statistics. 

At first glance, this data suggests that Northern Ireland performs better than other parts of the United Kingdom when it comes to cardiovascular disease (CVD). Age-standardised death rates and premature (under 75) death rates from CVD are lower than in England, particularly for men. However, relying on healthcare utilisation and mortality data alone provides an incomplete picture. Advances in treatment mean more people are living longer with CVD, often with fewer hospital interactions, and mortality statistics do not capture the wider burden of living with the disease.

To develop a more comprehensive account, we use the latest data, published in August 2025 from the Northern Ireland Health Survey, to examine inequalities in long-term heart conditions and key risk factors.

New data improves our understanding of CVD in Northern Ireland

The 2021 Northern Ireland Health Survey provides insight into the prevalence of angina and other long-term health conditions as well as key risk factors. Our analysis adjusts for both age and sex and uses the 2017 Northern Ireland Multiple Deprivation Measures and 2014 Local Government District boundaries to explore socioeconomic inequalities.

This dataset has some limitations. It is already four years old, underlining the significant data gaps in Northern Ireland compared to other parts of the UK. It was also collected during the pandemic, which reduced the sample size, making estimates less precise than in previous years. Younger adults (aged 16–44) are particularly underrepresented. Still, it remains a valuable source of more granular data on heart disease prevalence and risk factors. Due to insufficient sample sizes, instead of estimating prevalence for men and women separately, we include sex and gender in our logistical regressions to estimate the prevalence of heart disease and its risk factors. 

Heart disease is a far more pressing challenge in deprived communities

An estimated 5.6 per cent of people in Northern Ireland live with a long-term heart condition or angina. Among those aged under 75, the prevalence is slightly lower at 4.2 per cent. The burden of disease, however, is not evenly shared. After adjusting for age and sex, 4.4 per cent of people in the least deprived fifth of areas are affected, compared with 10 per cent in the most deprived fifth.

This means people in the most deprived areas are 2.3 times more likely to have a long-term heart condition or angina compared to those in the least deprived areas. Inequalities are even starker among people under 75, where the risk is around three times higher in the most deprived areas than in the least deprived.

Heart disease risk factors are higher in deprived communities

As well as considering the prevalence of long-term heart conditions, we examined inequalities in four key risk factors which drive CVD: obesity, smoking, diabetes, and hypertension. 

Both diabetes and hypertension greatly increase the risk of cardiovascular disease. Adults with diabetes are between two and four times more likely to develop cardiovascular problems compared to those without the condition. Hypertension is also one of the most important risk factors for nearly all acquired cardiovascular diseases.

Obesity not only increases the likelihood of developing diabetes but also directly contributes to cardiovascular disease and mortality. Smoking – both active and second-hand exposure – is responsible for more than 30 per cent of coronary heart disease mortality.

Across all these risk factors, the inequalities are stark. People living in the most deprived fifth of areas are 2.8 times more likely to smoke, 2.1 times more likely to have diabetes, 1.5 times more likely to have hypertension, and 1.2 times more likely to be living with obesity compared with those in the least deprived areas.

Interestingly, inequalities in obesity and hypertension are narrower than those for smoking and diabetes. This suggests that while deprivation drives health gaps, obesity and hypertension are challenges facing Northern Ireland’s population as a whole and require a cross-cutting approach.

There are stark geographical disparities in CVD prevalence and risk factors

Alongside deprivation, geography also plays a significant role in cardiovascular disease prevalence and risk factors. After adjusting for age and sex, an estimated 4 per cent of adults in Newry, Mourne and Down live with angina or another long-term heart condition, compared with 13 per cent in Causeway Coast and Glens - a rate three times higher.

We see similarly sharp gaps in risk factors. After adjusting for age and sex, we estimate that the gap between the best- and worst-performing local areas is four times higher for diabetes, 1.4 times higher for obesity, 1.7 times higher for hypertension, and 2.9 times higher for smoking.

Policy implications: Strengthening cardiovascular prevention at a critical moment

CVD continues to pose a substantial challenge for Northern Ireland’s health system. Prevalence remains high, inequalities are persistent and cardiac services are under sustained pressure at a time of severe financial constraint, with a £600 million funding gap across the health system. As this blog has made clear, CVD’s burden is not evenly distributed: those living in the most deprived communities are far more likely to live with CVD and be affected by its major risk factors.

In this context, it is vital that strategy meets the scale of the challenge. The recently published Health and Social Care Reset Planrightly prioritises prevention and community-based care. However, without targeted implementation, there is a risk that inequalities will widen and avoidable demand will continue to fall on an already overstretched acute system. Action on cardiovascular prevention is therefore central to both population health and system sustainability.

Recommendations

Target prevention where risk and demand are highest

Cardiovascular risk in Northern Ireland is heavily concentrated in specific geographical areas and among the most deprived communities. Prevention resources should therefore be focused where risk is highest. This approach is both equitable and efficient, as reducing risk in these populations will have the greatest impact on future demand for cardiac services.

The strongest case for targeted action lies with smoking and diabetes, which show the steepest inequality gradients. People in the most deprived areas are nearly three times more likely to smoke and twice as likely to have diabetes. Priority actions include proactive smoking cessation support delivered through primary care, pharmacies, and community organisations, alongside targeted diabetes prevention and early management for high-risk groups. These interventions are evidence-based, relatively low-cost, and well-aligned with the Three-Year Plan.

Combine targeted action with population-wide measures

For obesity and hypertension, inequality gaps are narrower, indicating the need for population-wide approaches alongside targeted support. The Three-Year Plan and the Healthy Futures Obesity Strategic Framework provide opportunities to improve food environments, support physical activity and active travel, and expand routine blood pressure checks in community settings. Done well, these measures can reduce overall cardiovascular risk while supporting equity.

Strengthen data and protect prevention under financial pressure

Significant gaps in cardiovascular data continue to limit Northern Ireland’s ability to target resources and monitor progress on inequalities. More consistent recording of risk factors, routine reporting by deprivation and geography, and closer linkage between prevention data and service pressure indicators would support more effective and timely action.

At the same time, the scale of the financial challenge means prevention risks being treated as secondary to managing pressures on acute services. In reality, protecting high-impact prevention activity and avoiding disproportionate cuts to community services are essential to preventing greater costs from avoidable acute care. Better data collection and outcomes monitoring can help build the case for investment in these settings.

Measuring progress

Finally, delivery of the Three-Year Plan should be judged by whether inequalities are narrowing. Key indicators include changes in cardiovascular disease prevalence between deprived and affluent communities, trends in high-burden council areas, and early warning signs such as rising emergency cardiac admissions.

Northern Ireland has a clear strategic direction and strong evidence on where action is most needed. What is now required is decisive, targeted implementation to reduce cardiovascular inequalities and protect the long-term sustainability of an already stretched health system.