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

Thora Majlund Kjærulff*, Kristine Bihrmann, Jinfeng Zhao, Daniel Exeter, Gunnar Gislason, Mogens Lytken Larsen, Annette Kjær Ersbøll

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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.

Original languageEnglish
JournalEuropean Journal of Preventive Cardiology
ISSN2047-4873
DOIs
Publication statusPublished - 2019

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Odds Ratio
Denmark
Linear Models

Keywords

  • AMI
  • epidemiology
  • geographical variation
  • nationwide individual-level registers
  • social inequality

Cite this

@article{18273a2e927240e3af1a54281777f093,
title = "Acute myocardial infarction: Does survival depend on geographical location and social background?",
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.",
keywords = "AMI, epidemiology, geographical variation, nationwide individual-level registers, social inequality",
author = "Kj{\ae}rulff, {Thora Majlund} and Kristine Bihrmann and Jinfeng Zhao and Daniel Exeter and Gunnar Gislason and Larsen, {Mogens Lytken} and Ersb{\o}ll, {Annette Kj{\ae}r}",
year = "2019",
doi = "10.1177/2047487319852680",
language = "English",
journal = "European Journal of Preventive Cardiology",
issn = "2047-4873",
publisher = "SAGE Publications",

}

Acute myocardial infarction : Does survival depend on geographical location and social background? / Kjærulff, Thora Majlund; Bihrmann, Kristine; Zhao, Jinfeng; Exeter, Daniel; Gislason, Gunnar; Larsen, Mogens Lytken; Ersbøll, Annette Kjær.

In: European Journal of Preventive Cardiology, 2019.

Research output: Contribution to journalJournal articleResearchpeer-review

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

Y1 - 2019

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

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

ER -