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Multicenter Study
. 2017 Feb 20;6(2):e005236.
doi: 10.1161/JAHA.116.005236.

Time Trends and Educational Inequalities in Out-of-Hospital Coronary Deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) Project

Enxhela Sulo  1 , Ottar Nygård  2   3 , Stein Emil Vollset  4   5 , Jannicke Igland  4 , Marta Ebbing  4   6 , Truls Østbye  4   7 , Torben Jørgensen  8   9   10 , Gerhard Sulo  4 , Grethe S Tell  4   6
Affiliations
Multicenter Study

Time Trends and Educational Inequalities in Out-of-Hospital Coronary Deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) Project

Enxhela Sulo et al. J Am Heart Assoc. .

Abstract

Background: Recent time trends and educational gradients characterizing out-of-hospital coronary deaths (OHCD) are poorly described.

Methods and results: We identified all deaths from coronary heart disease occurring outside the hospital in Norway during 1995 to 2009. Time trends were explored using Poisson regression analysis with year as the independent, continuous variable. Information on the highest achieved education was obtained from The National Education Database and classified as primary (up to 10 years of compulsory education), secondary (high school or vocational school), or tertiary (college/university). Educational gradients in OHCD were explored using Poisson regression, stratified by sex and age (<70 and ≥70 years), and results were expressed as incidence rate ratios (IRRs) and 95%CIs. Of 100 783 coronary heart disease deaths, 58.8% were OHCDs. From 1995 to 2009, age-adjusted OHCD rates declined across all education categories (primary, secondary, and tertiary) in younger men (IRR=0.35; 95%CI 0.32-0.38; IRR=0.38; 95%CI 0.35-0.42; IRR=0.33; 95%CI 0.28-0.40), younger women (IRR=0.47; 95% CI 0.40-0.56; IRR=0.55; 95%CI 0.45-0.67; IRR=0.28; 95% CI 0.16-0.47), older men (IRR=0.20; 95%CI 0.19-0.22; IRR=0.20; 95%CI 0.18-0.22; IRR=0.20; 95%CI 0.17-0.23), and older women (IRR=0.26; 95%CI 0.24-0.28; IRR=0.25; 95%CI 0.23-0.28; IRR=0.28; 95%CI 0.22-0.34). Tertiary education was associated with lower risk of OHCD compared to primary education (IRR=0.37; 95%CI 0.35-0.40 in younger men, IRR=0.26; 95%CI 0.22-0.30 in younger women, IRR=0.52; 95%CI 0.49-0.55 in older men, and IRR=0.61; 95%CI 0.57-0.66 in older women). These gradients did not change over time (P interaction=0.25).

Conclusions: Although OHCD rates declined substantially during 1995 to 2009, they displayed educational gradients that remained constant over time.

Keywords: Norway; coronary artery disease; educational inequalities; epidemiology; mortality; out‐of‐hospital coronary; trends.

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Figures

Figure 1
Figure 1
Proportion of out‐of‐hospital deaths within all coronary deaths by sex and age group in Norway: a CVDNOR project. Numbers in the parentheses represent the 95%CI. CVDNOR indicates Cardiovascular Disease in Norway Project.
Figure 2
Figure 2
Age‐standardized rates of out‐of‐hospital coronary deaths by education categories in Norway 1995 to 2009: a CVDNOR project. CVDNOR indicates Cardiovascular Disease in Norway Project.
See this image and copyright information in PMC

References

    1. Roth GA, Huffman MD, Moran AE, Feigin V, Mensah GA, Naghavi M, Murray CJ. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;132:1667–1678. - PubMed
    1. Dudas K, Lappas G, Stewart S, Rosengren A. Trends in out‐of‐hospital deaths due to coronary heart disease in Sweden (1991 to 2006). Circulation. 2011;123:46–52. - PubMed
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jimenez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER III, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–e60. - PubMed
    1. Capewell S, MacIntyre K, Stewart S, Chalmers JW, Boyd J, Finlayson A, Redpath A, Pell JP, McMurray JJ. Age, sex, and social trends in out‐of‐hospital cardiac deaths in Scotland 1986–95: a retrospective cohort study. Lancet. 2001;358:1213–1217. - PubMed
    1. Tunstall‐Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary‐event rates to changes in coronary heart disease mortality: 10‐year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999;353:1547–1557. - PubMed

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