Survival rate 28 days after hospital admission with first myocardial infarction. Inverse relationship with socio-economic circumstances
Version of Record online: 13 DEC 2005
Journal of Internal Medicine
Volume 259, Issue 2, pages 164–172, February 2006
How to Cite
GERWARD, S., TYDÉN, P., HANSEN, O., ENGSTRÖM, G., JANZON, L. and HEDBLAD, B. (2006), Survival rate 28 days after hospital admission with first myocardial infarction. Inverse relationship with socio-economic circumstances. Journal of Internal Medicine, 259: 164–172. doi: 10.1111/j.1365-2796.2005.01594.x
- Issue online: 13 DEC 2005
- Version of Record online: 13 DEC 2005
- myocardial infarction;
- socio-economic factors;
- urban population
Objective. To study to what extent geographical differences of the mortality from ischaemic heart disease (IHD) can be accounted for by the 28-day case fatality rate (CFR) following first hospital admittance for acute myocardial infarction (MI) and whether the geographical pattern of survival has any relationship with socio-economic circumstances.
Design. Register-based surveillance study.
Setting. Seventeen residential areas in Malmö, Sweden.
Subjects. All 5533 patients were admitted during 1986–1995 for a first acute MI at Malmö University Hospital.
Main outcome measures. CFR is based on record linkage with national registers. Area-specific cardiovascular and socio-economic scores (SES) are based on previous cross-sectional studies.
Results. In patients below 75 years of age, differences of the 28-day CFR accounted for 20–30% of the geographical variance in mortality from IHD. No corresponding association was found in older age groups. Patients from areas with low SES had the highest CFR, 23.8%. The odds ratios of fatal outcome for patients from areas with median and low SES (versus high SES) were 1.23 (95% CI: 1.01–1.50) and 1.25 (95% CI: 1.03–1.52), respectively (P for trend: 0.060). The strongest correlation was observed in men below 75 years of age (P for trend: 0.007). During the study period there was an improvement of the survival rate for patients from high and medium SES areas but no corresponding change for patients coming from areas having a low SES.
Conclusions. In patients below 75 years, geographical differences of the mortality from IHD were related to differences of the 28-day CFR following hospital admittance for a first MI. Rates of survival were inversely related to socio-economic circumstances in the patient's residential area.