Incidencia y letalidad por infarto agudo del miocardio en Chile: 2001-2007 / Incidence and case fatality due to acute myocardial infarction in Chile in the period 2001-2007

Background: Acute myocardial infarction (AMI) causes 73.6 percent of coronary heart disease (CHD) deaths in Chile. Aim: To estimate the incidence and case fatality of AMI and analyze their trends between 2001-2007. Material and Methods: A time-series study analyzing all cases of AMI (according to the International Classification of Diseases (ICD)-10, I21 code), registered in the National Hospitalizations and Death databases. Annual incidence rates and case fatality by sex and age groups were calculated. The direct method was used to standardize rates by age, using the World Health Organization 2000 Population. Prais-Winsten regression models were used to evaluate trends, expressed as relative change. Results: Between 2001 and 2007, we estimated that 83,754 cases of AMI occurred. Standardized annual incidence rate was 74.4 per 100,000 inhabitants (98.0 in men and 51.0 in women). Incidence rates increased by 34 percent in individuals < 45 years of age and 9.2 percent in the group 55-64 years (p < 0.001, both). Total case fatality was 49.5 percent (45.4 percent in men and 57.2 percent in women; p < 0.001), and its trend analysis showed a significant annual reduction of 1.2 percent in men and 0.81 percent in women. In-hospital case fatality was 14.2 percent (11.3 and 20.4 percent in men and women, respectively; p < 0.001). There was a significant annual reduction of mortality (0.57 and 1.01 percent in men and women, respectively (p < 0.05). Conclusions: The incidence of AMI was stable in the whole population, but increased in younger age groups. Total and in-hospital case-fatality decreased. Despite the greater reduction of case fatality in women, they still have a higher risk of dying while in hospital.

Mortalidad por cardiopatía isquémica en Chile: quiénes, cuántos y dónde / Mortality from ischemic heart disease in Chile: who, how many, and where

OBJETIVO: Describir las características de la mortalidad por cardiopatía isquémica en Chile y su evolución temporal, e identificar los factores asociados a mortalidad extrahospitalaria por esta patología entre 1997 y 2007. MÉTODOS. Estudio de serie temporal que utiliza las bases de defunciones del Departamento de Estadísticas e Información en Salud entre 1997 y 2007. De un total de 917 029 muertes notificadas, se seleccionaron aquellas cuya causa primaria fue cardiopatía isquémica (códigos I20 a I25 de la CIE-10). Se calcularon tasas crudas y ajustadas por edad y sexo para analizar la tendencia. Se analizaron las características de la mortalidad según el lugar de defunción, evaluando posibles factores asociados a mortalidad extrahospitalaria (casa/habitación u otro lugar), incluidos edad, ruralidad, estado civil, educación y sexo, así como el efecto de la incorporación del infarto agudo al miocardio a la ley de garantías en salud (GES), con regresión binomial. RESULTADOS: Durante el período estudiado se notificaron 87 342 muertes por cardiopatía isquémica, de las cuales 57,7 por ciento eran hombres y 59,5 por ciento ocurrieron fuera del hospital. La tasa de mortalidad ajustada por edad disminuyó de 52,9 a 40,4 por 100 000 habitantes. Los factores asociados a mortalidad extrahospitalaria en hombres fueron ruralidad, riesgo relativo (RR) 1,24 (1,21-1,27); edad mayor a 70 años, RR 1,03 (1,01-1,05); estado civil soltero, RR 1,10 (1,08-1,12), mientras que en las mujeres los valores correspondientes fueron 1,13 (1,10-1,18); 1,31 (1,27-1,36) y 1,07 (1,04-1,09). La adopción de la GES se asoció con un aumento en el porcentaje de muertes intrahospitalarias en mujeres, RR 0,95 (0,92-0,97). CONCLUSIONES: †La mortalidad por cardiopatía isquémica en Chile ha disminuido. El mayor porcentaje de las muertes ocurren fuera de hospitales o clínicas. Los factores asociados a mortalidad extrahospitalaria en ambos sexos fueron edad avanzada, estado civil soltero y ruralidad.

OBJECTIVE: To describe the characteristics of mortality from ischemic heart disease in Chile and its trend over time, and to identify the factors associated with extra-hospital mortality from this pathology between 1997 and 2007. METHODS: A time-series study was conducted using the mortality database of the Department of Health Statistics and Information for 1997 to 2007. Of the total of 917 029 deaths reported in this period, those whose primary cause was ischemic heart disease (ICD-10 codes I20-I25) were selected. Crude and adjusted rates were calculated by age and sex in order to analyze the trend. Mortality characteristics were analyzed by the place of death, evaluating potential factors associated with extra-hospital mortality (death at home or elsewhere outside a hospital or clinic). The factors considered, using binomial regression, were age, rurality, marital status, education, and sex, as well as the effect of the incorporation of acute myocardial infarction into the explicit health guarantees law. RESULTS: During the period in question, 87 342 deaths from ischemic heart disease were reported, 57.7 percent of which were in males and 59.5 percent outside the hospital. The age-standardized mortality rate declined from 52.9 to 40.4 per 100 000 population. Factors related to extra-hospital mortality in men were rurality, relative risk (RR) 1.24 (1.21-1.27); age of over 70 years, RR 1.03 (1.01-1.05); and being single, RR 1.10 (1.08-1.12). In women, the respective values were rurality, 1.13 (1.10-1.18); advanced age, 1.31 (1.27-1.36); and being single, 1.07 (1.04-1.09). Passage of the explicit health guarantees law was associated with an increase in the percentage of in-hospital deaths in women, RR 0.95 (0.92-0.97). CONCLUSIONS: Mortality from ischemic heart disease in Chile has declined. The majority of deaths from this cause occur outside hospitals or clinics. The factors associated with extra-hospital mortality in both sexes were advanced age, being single, and rurality.

Análisis de la tendencia de la mortalidad por cirrosis hepática en Chile: Años 1990 a 2007 / Mortality trend from liver cirrhosis in Chile from 1990 to 2007

Background: There is a worldwide tendency towards a reduction in the rates of deaths due to cirrhosis. In Chile, a decrease in the number of hospital admissions due to this disease has been recorded. Aim: To assess general characteristics and temporal evolution of liver cirrhosis mortality in Chile between 1990 and 2007. Material and Methods: National death records and population databases were reviewed. Crude and age-adjusted mortality rates for alcoholic and non-alcoholic cirrhosis were calculated, evaluating their evolution in the study period and the relative risk by gender. Results: In the study period, 44,894 deaths caused by cirrhosis were recorded. Mortality rate was 16.6 deaths per 100,000 inhabitants. 54 percent of deaths were attributed to non-alcoholic cirrhosis. There was a reduction in mortality rates for both types of cirrhosis. Males accounted for 83 and 65 percent of deaths caused by alcoholic and non-alcoholic cirrhosis, respectively. The figures for relative risk of death were 5 and 1.9, respectively. Conclusions: Alcoholic cirrhosis was the preponderant cause among liver cirrhosis deaths. A decrease in mortality rates was observed in the study period. Improvements in disease treatment and control could possibly explain this trend.