Abstract 5014: Increasing Survival to Hospital Following a Myocardial Infarction and Widening Socioeconomic Disparities in Scotland 1986–2005: A Population Study of 5.1 Million People
Introduction Out of hospital cardiac deaths (OHCD) represent a large and important proportion of total population coronary heart disease mortality. We examined trends in OHCD rates to determine if age, sex and socioeconomic differentials persist.
Methods We examined all first acute myocardial infarctions that occurred in 1986 –2005 registered in the linked Scottish Morbidity Record (all hospital admissions) and General Register Office death records in Scotland. We examined age and sex specific rates and age standardized rates by socioeconomic status (SES). Logistic regression was used to determine factors associated with survival to hospital following a myocardial infarction.
Results 311168 men (218268 women) experienced a first myocardial infarction and 74067 men (64084 women) died before reaching hospital. From 1986, rates (per 100000 population) fell from 82 to 22 in men under 65 years and from 1416 to 454 in those over 65 years in 2005 (in women the rates fell from 26 to 6 and 843 to 331 respectively). The rate ratio (low SES vs high SES in men) of age standardized rates, was 1.16(95%CI 1.07–1.26) in 1986 and increased to 1.58(1.37–1.82) in 2005. In women the ratios were 1.23(1.11–1.35) in 1986 and 1.30(1.11–1.52) in 2005. The proportion of men surviving to reach hospital increased from 68% in 1986 to 83% in 2005 and in women from 64% to 79%. The odds of reaching hospital alive improved over time (2005 vs 1986) but varied with age, with the biggest improvements among men OR=3.37(3.05–3.73) and women 2.94(2.41–3.59) ≤54 years. Low SES was associated with a reduction in the odds of reaching hospital alive after adjustment for comorbidities and year of event (Table⇓).
Conclusions Whilst the proportion of people surviving to reach hospital alive following a first myocardial infarction has increased, significant age and sex specific inequalities in OHCD rates exist with widening socioeconomic inequalities. These disparities need to be addressed in future prevention strategies.