Right: corresponding posterior … Figure 6 Left: total residual spatial effects of mortality risk associated with heart failure at ward level in Warwickshire; shown are the posterior means of the full model (IMD 2010, Over 50 and the 4 indicators of air pollution). Right: corresponding posterior … In general, there was consistently higher heart failure morbidity selleckchem risk in northern wards, particularly around Nuneaton and Bedworth, and lower heart failure morbidity risks in the southern

wards, particularly within the district of Stratford-on-Avon. However, all this variation could partially be accounted for within the model generated within this study (taking into account air pollution, age and social deprivation levels). Heart failure mortality risk was, in general, higher in northern

wards around Nuneaton and Bedworth as well as in some central areas around Warwick, Royal Leamington Spa and Kenilworth. Heart failure mortality risk was again lower in more southern wards particularly within Stratford-on-Avon. Unlike with morbidity, however, our model could not explain all this variation in heart failure mortality. Even after taking into account air pollution, age and social deprivation, the rate of death from heart failure remained significantly higher than would be expected in areas within and around Nuneaton, Bedworth, Warwick, Royal Leamington Spa and Kenilworth. In sensitivity

analyses, we tested several models and our results were not substantially altered after removing one or two pollutants (data not shown). Discussion Before even considering air pollution, this study helps to demonstrate the inequality of risk from heart failure disease and death that exists for individuals living in different parts of the county of Warwickshire. There is a significant excess risk of disease as well as death in more northern wards within and surrounding Nuneaton and Bedworth. Much (but not all) of this variation could be attributed to the air pollution, age structure and social AV-951 deprivation that exists in these areas according to our model. Measures that seek to address air pollution and social deprivation could be expected therefore to help mitigate against cardiovascular risks within these local populations. The present study corroborates the notion that air pollution is an increasingly important public health issue in Warwickshire. Higher levels of the average air pollution index looked at in this study correlated significantly with increased levels of heart failure morbidity as well as mortality across the county, even after removing the effects of age structure and social deprivation.