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BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Neighbourhood socioeconomic inequalities in incidence of acute myocardial infarction: a cohort study quantifying age- and gender-specific differences in relative and absolute terms

Authors: Carla Koopman, Aloysia AM van Oeffelen, Michiel L Bots, Peter M Engelfriet, WM Monique Verschuren, Lenie van Rossem, Ineke van Dis, Simon Capewell, Ilonca Vaartjes

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

Socioeconomic status has a profound effect on the risk of having a first acute myocardial infarction (AMI). Information on socioeconomic inequalities in AMI incidence across age- gender-groups is lacking. Our objective was to examine socioeconomic inequalities in the incidence of AMI considering both relative and absolute measures of risk differences, with a particular focus on age and gender.

Methods

We identified all patients with a first AMI from 1997 to 2007 through linked hospital discharge and death records covering the Dutch population. Relative risks (RR) of AMI incidence were estimated by mean equivalent household income at neighbourhood-level for strata of age and gender using Poisson regression models. Socioeconomic inequalities were also shown within the stratified age-gender groups by calculating the total number of events attributable to socioeconomic disadvantage.

Results

Between 1997 and 2007, 317,564 people had a first AMI. When comparing the most deprived socioeconomic quintile with the most affluent quintile, the overall RR for AMI was 1.34 (95 % confidence interval (CI): 1.32 – 1.36) in men and 1.44 (95 % CI: 1.42 – 1.47) in women. The socioeconomic gradient decreased with age. Relative socioeconomic inequalities were most apparent in men under 35 years and in women under 65 years. The largest number of events attributable to socioeconomic inequalities was found in men aged 45–74 years and in women aged 65–84 years. The total proportion of AMIs that was attributable to socioeconomic inequalities in the Dutch population of 1997 to 2007 was 14 % in men and 18 % in women.

Conclusions

Neighbourhood socioeconomic inequalities were observed in AMI incidence in the Netherlands, but the magnitude across age-gender groups depended on whether inequality was expressed in relative or absolute terms. Relative socioeconomic inequalities were high in young persons and women, where the absolute burden of AMI was low. Absolute socioeconomic inequalities in AMI were highest in the age-gender groups of middle-aged men and elderly women, where the number of cases was largest.
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Literature
1.
2.
Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A: Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol. 2010, 35: 72-115. 10.1016/j.cpcardiol.2009.10.002.CrossRefPubMedPubMedCentral
3.
Sundquist J, Malmstrom M, Johansson SE: Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Int J Epidemiol. 1999, 28: 841-845. 10.1093/ije/28.5.841.CrossRefPubMed
4.
Stjarne MK, Fritzell J, De Leon AP, Hallqvist J: Neighborhood socioeconomic context, individual income and myocardial infarction. Epidemiology. 2006, 17: 14-23. 10.1097/01.ede.0000187178.51024.a7.CrossRefPubMed
5.
Henriksson G, Weitoft GR, Allebeck P: Associations between income inequality at municipality level and health depend on context - a multilevel analysis on myocardial infarction in Sweden. Soc Sci Med. 2010, 71: 1141-1149. 10.1016/j.socscimed.2010.05.044.CrossRefPubMed
6.
Morrison C, Woodward M, Leslie W, Tunstall-Pedoe H: Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register. BMJ. 1997, 314: 541-546. 10.1136/bmj.314.7080.541.CrossRefPubMedPubMedCentral
7.
Chaix B, Rosvall M, Merlo J: Neighborhood socioeconomic deprivation and residential instability: effects on incidence of ischemic heart disease and survival after myocardial infarction. Epidemiology. 2007, 18: 104-111. 10.1097/01.ede.0000249573.22856.9a.CrossRefPubMed
8.
Sundquist K, Winkleby M, Ahlen H, Johansson SE: Neighborhood socioeconomic environment and incidence of coronary heart disease: a follow-up study of 25,319 women and men in Sweden. Am J Epidemiol. 2004, 159: 655-662. 10.1093/aje/kwh096.CrossRefPubMed
9.
Sundquist K, Malmstrom M, Johansson SE: Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. J Epidemiol Community Health. 2004, 58: 71-77. 10.1136/jech.58.1.71.CrossRefPubMedPubMedCentral
10.
Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL: Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001, 345: 99-106. 10.1056/NEJM200107123450205.CrossRefPubMed
11.
Davies CA, Dundas R, Leyland AH: Increasing socioeconomic inequalities in first acute myocardial infarction in Scotland, 1990–92 and 2000–02. BMC Public Health. 2009, 9: 134-10.1186/1471-2458-9-134.CrossRefPubMedPubMedCentral
12.
Deguen S, Lalloue B, Bard D, Havard S, Arveiler D, Zmirou-Navier D: A small-area ecologic study of myocardial infarction, neighborhood deprivation, and sex: a Bayesian modeling approach. Epidemiology. 2010, 21: 459-466. 10.1097/EDE.0b013e3181e09925.CrossRefPubMed
13.
Picciotto S, Forastiere F, Stafoggia M, D'Ippoliti D, Ancona C, Perucci CA: Associations of area based deprivation status and individual educational attainment with incidence, treatment, and prognosis of first coronary event in Rome, Italy. J Epidemiol Community Health. 2006, 60: 37-43. 10.1136/jech.2005.037846.CrossRefPubMedPubMedCentral
14.
Diez-Roux AV, Nieto FJ, Muntaner C, Tyroler HA, Comstock GW, Shahar E, Cooper LS, Watson RL, Szklo M: Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol. 1997, 146: 48-63. 10.1093/oxfordjournals.aje.a009191.CrossRefPubMed
15.
Winkleby M, Sundquist K, Cubbin C: Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med. 2007, 32: 97-106. 10.1016/j.amepre.2006.10.002.CrossRefPubMedPubMedCentral
16.
Witvliet MI, Kunst AE, Stronks K, Arah OA: Variations between world regions in individual health: a multilevel analysis of the role of socio-economic factors. Eur J Public Health. 2012, 22: 284-9. 10.1093/eurpub/ckr001.CrossRefPubMed
17.
Koek HL, de Bruin A, Gast A, Gevers E, Kardaun JW, Reitsma JB, Grobbee DE, Bots ML: Incidence of first acute myocardial infarction in the Netherlands. Neth J Med. 2007, 65: 434-441.PubMed
18.
Ament P, Kessels W: Regionaal Inkomensonderzoek: uitgebreide onderzoeksbeschrijving. 2008, Voorburg: Centraal Bureau voor de Statistiek (CBS)
19.
Reitsma JB, Kardaun JW, Gevers E, de BA, der WJ v, Bonsel GJ: [Possibilities for anonymous follow-up studies of patients in Dutch national medical registrations using the Municipal Population Register: a pilot study]. Ned Tijdschr Geneeskd. 2003, 147: 2286-2290.PubMed
20.
21.
Wahrendorf J: An estimate of the proportion of colo-rectal and stomach cancers which might be prevented by certain changes in dietary habits. Int J Cancer. 1987, 40: 625-628. 10.1002/ijc.2910400509.CrossRefPubMed
22.
Ramsay SE, Morris RW, Whincup PH, Papacosta O, Rumley A, Lennon L, Lowe G, Wannamethee SG: Socioeconomic inequalities in coronary heart disease risk in older age: contribution of established and novel coronary risk factors. J Thromb Haemost. 2009, 7: 1779-1786. 10.1111/j.1538-7836.2009.03602.x.CrossRefPubMedPubMedCentral
23.
Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grotvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Rasmussen NK, Regidor E, do Rosário-Giraldes M, Spuhler T, Mackenbach JP: Educational differences in smoking: international comparison. BMJ. 2000, 320: 1102-1107. 10.1136/bmj.320.7242.1102.CrossRefPubMedPubMedCentral
24.
Beckett M: Converging health inequalities in later life–an artifact of mortality selection. J Health Soc Behav. 2000, 41: 106-119. 10.2307/2676363.CrossRefPubMed
25.
Benzeval M, Green MJ, Leyland AH: Do social inequalities in health widen or converge with age? Longitudinal evidence from three cohorts in the West of Scotland. BMC Public Health. 2011, 11: 947-10.1186/1471-2458-11-947.CrossRefPubMedPubMedCentral
26.
Emberson JR, Whincup PH, Morris RW, Walker M: Social class differences in coronary heart disease in middle-aged British men: implications for prevention. Int J Epidemiol. 2004, 33: 289-296. 10.1093/ije/dyh006.CrossRefPubMed
27.
Hallqvist J, Lundberg M, Diderichsen F, Ahlbom A: Socioeconomic differences in risk of myocardial infarction 1971–1994 in Sweden: time trends, relative risks and population attributable risks. Int J Epidemiol. 1998, 27: 410-415. 10.1093/ije/27.3.410.CrossRefPubMed
28.
Manrique-Garcia E, Sidorchuk A, Hallqvist J, Moradi T: Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis. J Epidemiol Community Health. 2011, 65: 301-309. 10.1136/jech.2009.104075.CrossRefPubMed
29.
Eikemo TA, Bambra C, Joyce K, Dahl E: Welfare state regimes and income-related health inequalities: a comparison of 23 European countries. Eur J Public Health. 2008, 18: 593-599. 10.1093/eurpub/ckn092.CrossRefPubMed
30.
Subramanian SV, Kawachi I: Income inequality and health: what have we learned so far?. Epidemiol Rev. 2004, 26: 78-91. 10.1093/epirev/mxh003.CrossRefPubMed
31.
Gerber Y, Myers V, Goldbourt U, Benyamini Y, Drory Y: Neighborhood socioeconomic status and leisure-time physical activity after myocardial infarction a longitudinal study. Am J Prev Med. 2011, 41: 266-273. 10.1016/j.amepre.2011.05.016.CrossRefPubMed
32.
Manderbacka K, Elovainio M: The complexity of the association between socioeconomic status and acute myocardial infarction. Rev Esp Cardiol. 2010, 63: 1015-1018. 10.1016/S0300-8932(10)70222-0.CrossRefPubMed
33.
Chaix B, Lindstrom M, Rosvall M, Merlo J: Neighbourhood social interactions and risk of acute myocardial infarction. J Epidemiol Community Health. 2008, 62: 62-68. 10.1136/jech.2006.056960.CrossRefPubMed
34.
Diez Roux AV, Kershaw K, Lisabeth L: Neighborhoods and cardiovascular risk: beyond individual-level risk factors. Curr Cardiovasc Risk Rep. 2008, 2: 175-180. 10.1007/s12170-008-0033-0.CrossRef
35.
Singh-Manoux A, Nabi H, Shipley M, Gueguen A, Sabia S, Dugravot A, Marmot M, Kivimaki M: The role of conventional risk factors in explaining social inequalities in coronary heart disease: the relative and absolute approaches to risk. Epidemiology. 2008, 19: 599-605. 10.1097/EDE.0b013e3181761cdc.CrossRefPubMedPubMedCentral
36.
van Rossum CT, Shipley MJ, de MH v, Grobbee DE, Marmot MG: Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study. J Epidemiol Community Health. 2000, 54: 178-184. 10.1136/jech.54.3.178.CrossRefPubMedPubMedCentral
37.
Osler M, Rostgaard K, Sorensen TI, Madsen M: The effect of recurrent events on register-based estimates of level and trends in incidence of acute myocardial infarction. J Clin Epidemiol. 1999, 52: 595-600. 10.1016/S0895-4356(99)00032-3.CrossRefPubMed
38.
Barakat K, Stevenson S, Wilkinson P, Suliman A, Ranjadayalan K, Timmis AD: Socioeconomic differentials in recurrent ischaemia and mortality after acute myocardial infarction. Heart. 2001, 85: 390-394. 10.1136/heart.85.4.390.CrossRefPubMedPubMedCentral
39.
Clark WA, Deurloo MC, Dieleman FM: Residential mobility and neighbourhood outcomes. Housing Studies. 2006, 21: 323-342. 10.1080/02673030600585946.CrossRef
40.
Northridge ME: Public health methods–attributable risk as a link between causality and public health action. Am J Public Health. 1995, 85: 1202-1204. 10.2105/AJPH.85.9.1202.CrossRefPubMedPubMedCentral
41.
Silhol R, Zins M, Chauvin P, Chaix B: Investigating the spatial variability in incidence of coronary heart disease in the Gazel cohort: the impact of area socioeconomic position and mediating role of risk factors. J Epidemiol Community Health. 2011, 65: 137-143. 10.1136/jech.2009.087379.CrossRefPubMed
Metadata
Title
Neighbourhood socioeconomic inequalities in incidence of acute myocardial infarction: a cohort study quantifying age- and gender-specific differences in relative and absolute terms
Authors
Carla Koopman
Aloysia AM van Oeffelen
Michiel L Bots
Peter M Engelfriet
WM Monique Verschuren
Lenie van Rossem
Ineke van Dis
Simon Capewell
Ilonca Vaartjes
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-617

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