Trends in out-of-hospital ischaemic heart disease deaths 1992 to 2003 in southern Sweden.

AIMS: In western countries out-of-hospital ischaemic heart disease (IHD) deaths account for approximately 50-70% of all IHD deaths. The objective was to examine the trends in out-of-hospital IHD deaths in the Region of Skåne in southern Sweden, in different sex- and age-groups. METHODS: All 14,347 persons (range 24-110 years) in Skåne who died out-of-hospital between 1992 and 2003 from IHD (I410-I414; I20-I25) as the underlying cause of death. Subjects with previous admission for IHD since 1970 were excluded. Data were retrieved from the Swedish National Cause of Death and Patient Register. Age-standardized IHD mortality rates and trends were calculated using Poisson regression analysis. RESULTS: Age-standardized annual out-of-hospital IHD mortality rates from 1992-2003 decreased in men from 177±13 to 103±9/100,000 inhabitants (-4.7%; p<0.001) and in women from 142±11 to 96±9/100,000 (-2.7%; p<0.001). In men, the annual change in age-standardized IHD mortality rates were -5.3 % (p<0.001), -4.0 % (p<0.001) and -4.7 % (p<0.001), respectively, in the age groups 20-64 years, 65-74 years and ≥75 years. Corresponding figures in women were -4.4 % (p<0.001), -2.4 % (p=0.003) and -2.5 % (p<0.001). The proportion of IHD deaths occurring out-of-hospital was in these age groups 50%, 40% and 35% respectively. CONCLUSIONS: In Skåne, out-of-hospital mortality in IHD deaths decreased significantly between 1992 and 2003. The decrease is more pronounced in men than women, and at the end of the study period in 2003, rates were almost equal. The proportion of IHD deaths occurring outside hospital was higher in younger people than in older people.

Survival rate 28 days after hospital admission with first myocardial infarction. Inverse relationship with socio-economic circumstances.

OBJECTIVE: To study to what extent geographical differences of the mortality from ischaemic heart disease (IHD) can be accounted for by the 28-day case fatality rate (CFR) following first hospital admittance for acute myocardial infarction (MI) and whether the geographical pattern of survival has any relationship with socio-economic circumstances. DESIGN: Register-based surveillance study. SETTING: Seventeen residential areas in Malmö, Sweden. SUBJECTS: All 5533 patients were admitted during 1986-1995 for a first acute MI at Malmö University Hospital. Main outcome measures. CFR is based on record linkage with national registers. Area-specific cardiovascular and socio-economic scores (SES) are based on previous cross-sectional studies. RESULTS: In patients below 75 years of age, differences of the 28-day CFR accounted for 20-30% of the geographical variance in mortality from IHD. No corresponding association was found in older age groups. Patients from areas with low SES had the highest CFR, 23.8%. The odds ratios of fatal outcome for patients from areas with median and low SES (versus high SES) were 1.23 (95% CI: 1.01-1.50) and 1.25 (95% CI: 1.03-1.52), respectively (P for trend: 0.060). The strongest correlation was observed in men below 75 years of age (P for trend: 0.007). During the study period there was an improvement of the survival rate for patients from high and medium SES areas but no corresponding change for patients coming from areas having a low SES. CONCLUSIONS: In patients below 75 years, geographical differences of the mortality from IHD were related to differences of the 28-day CFR following hospital admittance for a first MI. Rates of survival were inversely related to socio-economic circumstances in the patient's residential area.