Abstract. Engstro Èm G, Berglund G, Go Èransson M, Hansen O, Hedblad B, Merlo J, Tyde Ân P, Janzon L (Malmo È University Hospital, Malmo È, Sweden). Distribution and determinants of ischaemic heart disease in an urban population. A study from the myocardial infarction register in Malmo È, Sweden. J Intern Med 2000: 247; 588±596.Objective. Age adjusted incidence of myocardial infarction has been found to vary substantially between the residential areas of the city of Malmo È. The objective of this study was to assess the extent to which major biological risk factors and socioeconomic circumstances account for the differences in incidence of and mortality from myocardial infarction. Design. Ecological study of risk factor prevalence and incidence and mortality from myocardial infarction. Setting. Seventeen administrative areas in Malmo È, Sweden. Subjects. Assessment of risk factor prevalence was based on 28 466 men and women, ranging from 45 to 73 years old, who were recruited as participants in the Malmo È Diet and Cancer study. Information on serum lipids was available in a random subsample of 5362 subjects. Information about socio-economic level of the residential area was based on statistics from the Malmo È City Council and Statistics Sweden. Main outcome measures. Weighted least square regressions between prevalence of risk factors (i.e. smoking, hypertension, obesity, diabetes, hypercholesterolemia and hypertriglyceridemia), a myocardial infarction risk score, a socio-economic score and incidence and mortality from myocardial infarction. Results. The risk factor prevalence and myocardial infarction incidence was highest in areas with low socio-economic level. Prevalence of smoking, obesity and hypertension was significantly associated with myocardial infarction incidence and mortality rates amongst men (all r . 0.60). Prevalence of smoking was significantly associated with incidence and mortality from myocardial infarction amongst women (r = 0.66 and r = 0.61, respectively). A myocardial infarction risk score based on four biological risk factors explained 40±60% of the intra-urban geographical variation in myocardial infarction incidence and mortality. The socio-economic score added a further 2±16% to the explained variance. Conclusion. In an urban population with similar access to medical care, well-known biological cardiovascular risk factors account for a substantial proportion of the intra-urban geographical variation of incidence of and mortality from myocardial infarction. The socio-economic circumstances further contribute to the intra-urban variation in disease.
Identification of incident myocardial infarction (MI) cases in a defined population using hospital discharge data and mortality data in combination has been suggested. This method of case identification was compared to that of use of MI community registers set up in accordance with principles adopted in a World Health Organization collaborative programme. The comparison comprised data for four Swedish cities over a number of years. On average 81% of incident hospital-treated cases below 65 years of age identified through MI community registers were found by the retrospective use of the method based on hospital discharge data and mortality data. Of hospital-treated cases identified by the latter method, 83% were also found by the MI community registers. For cases fulfilling the diagnostic criteria employed by the MI community registers this proportion would be higher, probably 87%-92%. Several reasons for cases being missed by either method were suggested by the results. According to the findings of this study, the case identification of the method based on hospital discharge data and mortality data seems to be somewhat less efficient compared to use of MI community registers. This may be of importance in descriptive epidemiological studies, but is of less significance in analytical studies. The relative efficiency of the former method could be improved by a more reliable system for the recording of hospital discharges. If supplemented by a validation procedure, it could yield sufficiently accurate data for many epidemiological applications at a fairly low cost.
AimTo assess to what extent intra-urban variations and time trends of mortality in ischaemic heart disease are related to incidence of disease.
Methods and ResultsIncidence and mortality data were retrieved from the myocardial infarction register in Malmö. Age-and sex-adjusted incidence varied between the 17 city areas from 469 to 681/10 5 (P=0·003), and mortality from 286 to 446/10 5 (P=0·017). Socio-demographic risk factors for ischaemic heart disease were more prevalent in high rate areas. About 70% of the variance in mortality was explained by the variance in incidence. From 1986 to 1992, incidence declined by 3·6%/year in men (P=0·004) and by 0·9%/year in women (P=0·31). Mortality decreased by 4·1%/year in men (P=0·01) and by 1·9%/year in women (P=0·15). Incidence and mortality changes were statistically significant only in men>65. In younger age groups, incidence and mortality decreased in men but increased in women.
ConclusionsIn this urban population, there were large intra-city differences in mortality from ischaemic heart disease. During the period 1986-1992 there was a parallel decline in mortality and incidence. There were, however, substantial variations both in terms of residence and subject.
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