Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep 13;3(9):e003415.
doi: 10.1136/bmjopen-2013-003415.

Myocardial infarction incidence and survival by ethnic group: Scottish Health and Ethnicity Linkage retrospective cohort study

Narinder Bansal  1 , Colin M Fischbacher, Raj S Bhopal, Helen Brown, Markus Fc Steiner, Simon Capewell; Scottish Health and Ethnicity Linkage Study
Collaborators, Affiliations

Myocardial infarction incidence and survival by ethnic group: Scottish Health and Ethnicity Linkage retrospective cohort study

Narinder Bansal et al. BMJ Open. .

Abstract

Objective: Inequalities in coronary heart disease mortality by country of birth are large and poorly understood. However, these data misclassify UK-born minority ethnic groups and provide little detail on whether excess risk is due to increased incidence, poorer survival or both.

Design: Retrospective cohort study.

Setting: General resident population of Scotland.

Participants: All those residing in Scotland during the 2001 Census were eligible for inclusion: 2 972 120 people were included in the analysis. The number still residing in Scotland at the end of the study in 2008 is not known.

Primary and secondary outcome measures: As specified in the analysis plan, the primary outcome measures were first occurrence of admission or death due to myocardial infarction and time to event. There were no secondary outcome measures.

Results: Acute myocardial infarction (AMI) incidence risk ratios (95% CIs) relative to white Scottish populations (100) were highest among Pakistani men (164.1 (142.2 to 189.2)) and women (153.7 (120.5, 196.1)) and lowest for men and women of Chinese (39.5 (27.1 to 57.6) and 59.1 (38.6 to 90.7)), other white British (77 (74.2 to 79.8) and 72.2 (69.0 to 75.5)) and other white (83.1 (75.9 to 91.0) and 79.9 (71.5 to 89.3)) ethnic groups. Adjustment for educational qualification did not eliminate these differences. Cardiac intervention uptake was similar across most ethnic groups. Compared to white Scottish, 28-day survival did not differ by ethnicity, except in Pakistanis where it was better, particularly in women (0.44 (0.25 to 0.78)), a difference not removed by adjustment for education, travel time to hospital or cardiac intervention uptake.

Conclusions: Pakistanis have the highest incidence of AMI in Scotland, a country renowned for internationally high cardiovascular disease rates. In contrast, survival is similar or better in minority ethnic groups. Clinical care and policy should focus on reducing incidence among Pakistanis through more aggressive prevention.

Keywords: Epidemiology; Public Health.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) First myocardial infarction age adjusted risk ratios with 95% CI 1 May 2001 to 30 April 2008 in people 30–74 years, by ethnic group and sex. (B) First myocardial infarction age and education adjusted risk ratios with 95% CI 1 May 2001 to 30 April 2008 in people 30–74years, by ethnic group and sex.
Figure 2
Figure 2
Cardiac intervention uptake age adjusted risk ratios with 95% CI by ethnic group.
See this image and copyright information in PMC

References

    1. Mackay J, Mensah G. The atlas of heart disease and stroke. Geneva: World Health Organization, 2004
    1. Anand SS, Yusuf S, Vuksan V, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet 2000;356:279–84 - PubMed
    1. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation 2001;104:2855–64 - PubMed
    1. Wild SH, Fischbacher C, Brock A, et al. Mortality from all causes and circulatory disease by country of birth in England and Wales 2001–2003. J Public Health (Oxf) 2007;29:191–8 - PubMed
    1. Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998;97:596–601 - PubMed

LinkOut - more resources