Abstract
BackgroundThere have been substantial declines in ischemic heart disease in Scotland, partly due to decreases in acute myocardial infarction (AMI) incidence and case fatality (CF). Despite this, Scotland's IHD mortality rates are among the worst in Europe. We examine trends in socioeconomic inequalities in short-term CF after a first AMI event and their associations with age, sex, and geography.MethodsWe used linked hospital discharge and death records covering the Scottish population (5.1 million). Between 1988 and 2004, 178,781 of 372,349 patients with a first AMI died on the day of the event (Day0 CF) and 34,198 died within 28 days after surviving the day of their AMI (Day1-27 CF).ResultsAge-standardized Day0 CF at 30+ years decreased from 51% in 1988-90 to 41% in 2003-04. Day1-27 CF decreased from 29% to 18% over that period. Socioeconomic inequalities in Day0 CF existed for both sexes and persisted over time. The odds of case fatality for men aged 30-59 living in the most deprived areas in 2000-04 were 1.7 (95%CI: 1.3-2.2) times as high as in the least deprived areas and 1.9 (1.1-3.2) times as high for women. There was little evidence of socioeconomic inequality in Day1-27 CF in men or women. After adjustment for socioeconomic deprivation, significant geographic variation still remained for both CF definitions.ConclusionsA high proportion of AMI incidents in Scotland result in death on the day of the first event; many of these are sudden cardiac deaths. Short-term CF has improved, perhaps reflecting treatment advances and reductions in first AMI severity. However, persistent socioeconomic and geographic inequalities suggest these improvements are not uniform across all population groups, emphasizing the need for population-wide primary prevention.
Highlights
Declining ischemic heart disease (IHD) mortality in the world’s developed regions can be partly explained by decreasing incidence of the disease, suggesting effective primary prevention measures, and partly by reduced case fatality rates, reflecting improved primary and secondary care [1]
Between 1988 and 2004, 178,781 patients with a first acute myocardial infarction (AMI) died on the day of their event, and of the 192,568 patients who survived the day of their first AMI, 34,198 died within 28 days
Inequalities in 28-day case fatality following a first AMI There has been a significant drop in 28-day case fatality among those who survive the day of their first AMI event
Summary
Declining ischemic heart disease (IHD) mortality in the world’s developed regions can be partly explained by decreasing incidence of the disease, suggesting effective primary prevention measures, and partly by reduced case fatality rates, reflecting improved primary and secondary care [1]. Despite large reductions in rates, there remain strong regional differences [9,10] and socioeconomic inequalities [10,11] in IHD mortality in Scotland This partly reflects increasing socioeconomic and geographic variations in AMI incidence [2] as well as similar patterning of AMI case fatality. The majority of Scottish studies exploring the effect of deprivation on AMI case fatality have shown that socioeconomic inequalities exist [5,6,7,12,13,14]. Such inequalities contribute to the gradient in IHD mortality. We examine trends in socioeconomic inequalities in short-term CF after a first AMI event and their associations with age, sex, and geography
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