The European Journal of Public Health Advance Access originally published online on July 11, 2008
The European Journal of Public Health 2008 18(5):533-538; doi:10.1093/eurpub/ckn059
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Mortality |
Income and short-term case fatality after myocardial infarction in the whole middle-aged population of Malmö, Sweden
Maria Rosvall1, Sofia Gerward2,3, Gunnar Engström2 and Bo Hedblad2
1 Department of Clinical Sciences, Social Epidemiology, Lund University, Malmö University Hospital, Malmö, Sweden
2 Department of Clinical Sciences, Epidemiology Research Group, Lund University, Malmö University Hospital, Malmö, Sweden
3 Department of Cardiology, Malmö University Hospital, Malmö, Sweden
Correspondence: Maria Rosvall, Department of Clinical Sciences, Social Epidemiology, Clinical Research center, Building 28, level 12, Malmö University Hospital, SE-205 02 Malmö, Sweden, tel: + 46 40 39 10 00, fax: + 46 40 39 13 00, e-mail: maria.rosvall{at}med.lu.se
Received November 30, 2007 , accepted June 9, 2008
Background: There are no previous studies investigating when and where those who die pre-hospitally after an AMI paid their last visit to medical care. Methods and Results: Incidence of AMI, pre-hospital and 28-day case fatality rates were monitored over 13 years of follow-up, in relation to sex-specific quartiles of annual income in all inhabitants aged 40–64 years in Malmö, Sweden. Both incidence and short-term case fatality were inversely related to income. In all, 60–70% of all deaths within 28 days after the AMI were pre-hospital deaths. As compared with the lowest income group, the highest income group had lower odds of pre-hospital death with an age- and time-to-event-adjusted odds ratio of 0.5 (95% CI 0.4–0.8) for men and 0.3 (95% CI 0.1–0.6) for women. On the other hand, while 72% of those in the lowest two income groups had paid a visit to the medical services during the three months before death, only 59% had done so in the two highest income groups (P < 0.05). Conclusions: Poor socioeconomic circumstances increase the risk of pre-hospital death after an AMI. Of the pre-hospital deaths, the proportion who had visited the medical services during the 3 months preceding their AMI was higher among those from lower income groups. However, many of those suffering a pre-hospital death had visited clinics that normally do not treat coronary symptoms. If more patients were identified at an earlier stage this might increase the number of patients reaching hospital alive.
Keywords: acute myocardial infarction, case fatality, socioeconomic factors