Acute myocardial infarction: Does survival depend on geographical location and social background?

Author:

Kjærulff Thora Majlund1,Bihrmann Kristine1,Zhao Jinfeng2,Exeter Daniel2,Gislason Gunnar1345,Larsen Mogens Lytken6,Ersbøll Annette Kjær1

Affiliation:

1. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

2. Department of Population Health, Auckland University, New Zealand

3. Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark

4. Faculty of Health and Medical Sciences, University of Copenhagen, Denmark

5. The Danish Heart Foundation, Copenhagen, Denmark

6. Danish Centre of Inequalities in Health, Aalborg University Hospital, Denmark

Abstract

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.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Epidemiology

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