TY - JOUR

T1 - Acute myocardial infarction

T2 - Does survival depend on geographical location and social background?

AU - Kjærulff, Thora Majlund

AU - Bihrmann, Kristine

AU - Zhao, Jinfeng

AU - Exeter, Daniel

AU - Gislason, Gunnar

AU - Larsen, Mogens Lytken

AU - Ersbøll, Annette Kjær

PY - 2019/11

Y1 - 2019/11

N2 - Aims: This study described the interplay between geographical and social inequalities in survival after incident acute myocardial infarction (AMI) and examined whether geographical variation in survival exists when accounting for sociodemographic characteristics of the patients and their neighbourhood. Methods: Ringmap visualization and generalized linear models were performed to study post-AMI mortality. Three individual-level analyses were conducted: immediate case fatality, mortality between days 1 and 28 after admission and 365-day survival among patients who survived 28 days after admission. Results: In total, 99,013 incident AMI cases were registered between 2005 and 2014 in Denmark. Survival after AMI tended to correlate with sociodemographic indicators at the municipality level. In individual-level models, geographical inequality in immediate case fatality was observed with high mortality in northern parts of Jutland after accounting for sociodemographic characteristics. In contrast, no geographical variation in survival was observed among patients who survived 28 days. In all three analyses, odds and rates of mortality were higher among patients with low educational level (odds ratio (OR) (95% credible intervals) of 1.20 (1.12–1.29), OR of 1.12 (1.01–1.24) and mortality rate ratio of 1.45 (1.30–1.61)) and low income (OR of 1.24 (1.15–1.33), OR of 1.33 (1.20–1.48) and mortality rate ratio of 1.25 (1.13–1.38)). Conclusion: Marked geographical inequality was observed in immediate case fatality. However, no geographically unequal distribution of survival was found among patients who survived 28 days after AMI. Results additionally showed social inequality in survival following AMI.

AB - Aims: This study described the interplay between geographical and social inequalities in survival after incident acute myocardial infarction (AMI) and examined whether geographical variation in survival exists when accounting for sociodemographic characteristics of the patients and their neighbourhood. Methods: Ringmap visualization and generalized linear models were performed to study post-AMI mortality. Three individual-level analyses were conducted: immediate case fatality, mortality between days 1 and 28 after admission and 365-day survival among patients who survived 28 days after admission. Results: In total, 99,013 incident AMI cases were registered between 2005 and 2014 in Denmark. Survival after AMI tended to correlate with sociodemographic indicators at the municipality level. In individual-level models, geographical inequality in immediate case fatality was observed with high mortality in northern parts of Jutland after accounting for sociodemographic characteristics. In contrast, no geographical variation in survival was observed among patients who survived 28 days. In all three analyses, odds and rates of mortality were higher among patients with low educational level (odds ratio (OR) (95% credible intervals) of 1.20 (1.12–1.29), OR of 1.12 (1.01–1.24) and mortality rate ratio of 1.45 (1.30–1.61)) and low income (OR of 1.24 (1.15–1.33), OR of 1.33 (1.20–1.48) and mortality rate ratio of 1.25 (1.13–1.38)). Conclusion: Marked geographical inequality was observed in immediate case fatality. However, no geographically unequal distribution of survival was found among patients who survived 28 days after AMI. Results additionally showed social inequality in survival following AMI.

KW - AMI

KW - epidemiology

KW - geographical variation

KW - nationwide individual-level registers

KW - social inequality

U2 - 10.1177/2047487319852680

DO - 10.1177/2047487319852680

M3 - Journal article

C2 - 31126196

AN - SCOPUS:85066849146

VL - 26

SP - 1828

EP - 1839

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

IS - 17

ER -