Which populations in Europe score the highest for coronary heart decease and stomach cancer
Executive summary
Coronary heart disease and broader cardiovascular mortality are concentrated in Central and Eastern Europe, with countries such as Bulgaria and several middle‑income post‑communist states recording the highest age‑standardised death rates; authoritative reviews and EU statistics consistently point to an East–West gradient in burden and poorer outcomes in middle‑income countries [1] [2] [3]. Reporting on stomach (gastric) cancer in Europe in the supplied sources is sparse and mixed: one country-level study highlights stomach cancer as a leading cancer cause in men in Portugal, but the dataset here does not provide a Europe‑wide ranking for stomach cancer comparable to the cardiovascular data [4].
1. Coronary heart disease: an East‑West divide with Bulgaria and other middle‑income countries worst hit
Multiple recent pan‑European analyses show ischaemic heart disease (coronary heart disease, CHD) and overall cardiovascular disease (CVD) mortality are substantially higher in Central and Eastern Europe and in middle‑income countries than in high‑income Western and Northern Europe, with age‑standardised mortality rates from IHD nearly twice as high in men compared with women and overall CVD mortality ≥2.5 times higher in middle‑income versus high‑income countries as reported by the European Society of Cardiology Atlas [1]. Eurostat data illustrate dramatic intercountry variation within the EU — for example, standardised death rates for circulatory diseases in Bulgaria were reported as 6.3 times those in France in 2022 — underscoring that Bulgaria is among the worst‑affected EU members [2]. Academic reviews and public‑health literature trace this pattern to higher prevalence of classical risk factors (smoking, unhealthy diet, alcohol, uncontrolled blood pressure), lower access to or use of advanced cardiac procedures and variable primary care systems in parts of Eastern and Central Europe, with studies citing elevated CHD incidence in Russia, Poland, Hungary and the Czech Republic during periods of rising events [5] [3] [6].
2. Who bears the burden within Europe: men, lower‑income countries and some immigrant groups
The burden of CHD is not evenly distributed by sex, income or ethnicity: age‑standardised mortality is higher in males, and middle‑income countries carry a disproportionate share of CHD deaths compared with high‑income peers [1]. The ESC and WHO reporting note stark socio‑economic and geographic disparities across the WHO European Region, with premature CVD deaths (<70 years) generating tens of millions of lost life years and concentrated in less affluent populations [7] [8]. The ESC also highlights that some ethnic minority groups—such as South Asians in the UK and North America—have elevated CHD risk compared with indigenous white populations, although patterns differ across settings and are shaped by social determinants including racism, access and discrimination [1].
3. Stomach cancer: limited, country‑specific signals rather than a clear continental hotspot
The supplied reporting gives only fragmentary evidence on gastric cancer geography; one long‑term Portuguese analysis identifies stomach cancer among the top causes of cancer mortality in Portuguese men, alongside lung cancer, while noting that Portugal historically had higher cerebrovascular than coronary mortality [4]. No comprehensive Europe‑wide stomach cancer ranking or clear regional cluster comparable to the CHD East–West pattern appears in the provided sources, leaving the question of which European populations "score highest" for stomach cancer unresolved by these documents [4]. Broader cancer surveillance (not supplied here) would be required to produce a definitive, age‑standardised country ranking.
4. Why the patterns exist — and how reporting, data and policy shape perception
Reports converge on common drivers: higher prevalence of tobacco and harmful alcohol use, unhealthy diets, hypertension and limited access to timely acute and preventive cardiac care in Central and Eastern Europe explain much of the CHD gradient, while improvements in Western/Nordic countries reflect better primary prevention, acute care and secondary prevention measures [3] [1] [9]. Data production and health system capacity also bias what gets counted: middle‑income countries may underuse diagnostic procedures and coronary interventions and have different coding or surveillance quality, which can both mask and magnify apparent differences [5] [1]. Sources such as the OECD, ESC and WHO bring institutional perspectives and agendas — promoting prevention and health system investment — which should be read alongside independent academic reviews that call for better surveillance and targeted public‑health action [10] [7] [8].
5. Bottom line and limits of the evidence provided
The evidence in these sources makes clear that coronary heart disease burden is highest in Central and Eastern Europe and in several middle‑income European countries, with Bulgaria repeatedly flagged as extreme within the EU; by contrast, the supplied materials do not offer a comprehensive, comparable Europe‑wide ranking for stomach cancer beyond country‑level notes such as Portugal’s pattern, so a definitive answer on European stomach‑cancer hotspots cannot be made from these documents alone [2] [1] [4].