How Educational Inequalities in Cardiovascular Mortality Evolve While Healthcare Insurance Coverage Grows: Colombia, 1998 to 2015.

ABSTRACT

OBJECTIVES: We aim to explore how the current increase in Healthcare Insurance Coverage in Colombia potentially affected educational inequalities in cardiovascular disease (CVD) mortality from 1998 to 2015. METHODS: The official death database for the period 1998 to 2015, codified by cause of death for CVD (International Classification of Diseases, Tenth Revision I00-I99) was analyzed (men = 279 537, women = 292 122). We compared Healthcare Insurance Coverage (HIC) fluctuations with the trends and annual percentage changes (APCs) in CVD age-standardized mortality rates (ASMRs), the rate ratios of the ASMR to educational level, and the Relative Index of Inequality (RII), which was used to measure the educational inequalities. RESULTS: Mortality from CVD is higher in men than in women (ASMR/men = 148.2; 95% CI 147.6-148.7 vs ASMR/women = 139.4; 95% CI 138.9-139.9). People with a lower educational level have an increased risk of dying prematurely owing to CVD, the higher inequalities being those for young women (RII = 2.62; 95% CI 2.60-2.64). Inequalities by educational level (APC of the RII) grew at a rate of 2.5% per year in men and 1.7% in women, despite the steady increase of HIC throughout the period. From 1998 to 2011, there was a significant decrease in mortality rates owing to CVD (APC = -2.4% and APC = -2.1% for men and women, respectively). As of 2011, there was an increase only for men (APC = +3.9%). CONCLUSIONS: In Colombia, educational inequalities could be a cause of the worrying increase in mortality caused by CVD, which affects women more than men, whereas the HIC seem to be ineffective at reducing educational inequalities, and therefore mortality by CVD.