Analysis of inequality in cardiovascular mortality in Isfahan County: a retrospective registry-based study of social and demographic determinants.

Cardiovascular diseases (CVDs) are the leading cause of mortality in Iran, yet the distribution of this burden across social groups is poorly understood. This retrospective registry-based study analyzed the mortality data from 2018 to 2024 within Isfahan County to quantify socio-demographic inequalities. During the study period, a total of 177,899 deaths were recorded, of which 65,594 (36.8%) were attributed to cardiovascular diseases. Using the Wagstaff-normalized Concentration Index (CI), we found significant age differences (CI = 0.298), with hypertension mortality most concentrated among the elderly. While one third of educational data were missing, a significant pro-poor inequality was observed based on education (CI=-0.126), indicating a higher concentration of mortality among less-educated individuals. Subgroup analyses revealed dramatically that age-based inequality was dramatically more pronounced among Afghan nationals (CI = 0.591) compared to Iranians (CI = 0.285), and was slightly more severe in females than males. These findings suggest that CVDs mortality is disproportionately borne by the elderly, the less educated, and marginalized migrant groups, underscoring an urgent need for public health policies that target these vulnerable populations through equitable access to care and tailored risk factor management.