Coronary heart disease incidence and short-term case fatality in relation to socio-economic circumstances - epidemiological and clinical aspects

Abstract: The aim of this thesis was to study incidence and case-fatality rate (CFR) of myocardial infarction (MI) and ischemic heart disease (IHD), by exploring relations to socioeconomic position (SEP), other cardiovascular risk factors, medical seeking pattern and time trends. Data from the Malmö Myocardial Infarction Register (1986-1995; n=5533), the Malmö 1990 cohort (1990-2003; n=69 223), the Malmö Preventive Project (19742004; n=33 224) and out-of-hospital IHD deaths in southern Sweden (1992-2003; n=14 347) were used. The incidence and mortality of MI and IHD were followed using national and local registers. In patients below 75 years, 28-day CFR and survival after first MI was inverse associated to the SEP of the patient’s residential area. Both incidence and 28-day CFR after first MI were inversely related to income, out-of-hospital deaths (i.e. pre-hospital deaths) having the largest differences. Preceding their MI death, low compared to high income groups had more frequently contacted the medical services. Being unmarried, independently of other risk factors, increased the risk for and dying from a first coronary event (CE). In southern Sweden deaths due to IHD occurring out-of-hospital has during the period 1992 to 2003 decreased significantly, however, being more in men. The proportion of IHD deaths occurring outside hospital was higher in younger than older cases. In conclusion, living in a deprived area, having a low income and being unmarried increase the risk for a CE, decreases the chance of reaching hospital alive and increases the risk of dying from the event.