Abstract
BackgroundDespite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments. Previous research lacks evidence on how social inequalities in incidence and mortality risks developed over time, and on how these developments affect the lifespan free of MI and after MI in different social subgroups. This study investigates income inequalities in MI-free life years and life years after MI and whether these inequalities widened or narrowed over time.MethodsThe analyses are based on claims data of a large German health insurance provider insuring approximately 2.8 million individuals in the federal state Lower Saxony. Trends in income inequalities in incidence and mortality were assessed for all subjects aged 60 years and older by comparing the time periods 2006–2008 and 2015–2017 using multistate survival models. Trends in the number of life years free of MI and after MI were calculated separately for income groups by applying multistate life table analyses.ResultsMI incidence and mortality risks decreased over time, but declines were strongest among men and women in the higher-income group. While life years free of MI increased in men and women with higher incomes, no MI-free life years were gained in the low-income group. Among men, life years after MI increased irrespective of income group.ConclusionsIncome inequalities in the lifespan spent free of MI and after MI widened over time. In particular, men with low incomes are disadvantaged, as life years spent after MI increased, but no life years free of MI were gained.
Highlights
Despite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments
The data were collected for accounting purposes and include in- and outpatient diagnoses coded according to the International Classification of Disease 10th revision (ICD-10), demographic and socioeconomic information and the date of death for all individuals deceased during the observation period
Since the study population is limited to individuals aged 60 years and older and includes many individuals after retirement age, a considerable proportion of the individuals belong to the low-income group
Summary
Despite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments. According to Fries’ morbidity compression hypothesis [18, 19], improved prevention may lead to postponements of disease onset over time and to prolonged periods spent in good health. A recent study reported decreasing incidence rates and increasing age at MI onset among men, pointing towards morbidity compression [20]. Improvements in therapy have increased survival rates after MI substantially [10, 13, 21, 22], leading to prolonged periods spent after MI and contributing to an expansion of morbidity [23]. For Germany, both decreasing incidence rates and mortality rates after MI onset have been reported [16, 24] It largely remains unclear whether a compression or an expansion has taken place among the German population and whether these developments depend on socioeconomic characteristics
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