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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Ethnic inequalities in acute myocardial infarction and stroke rates in Norway 1994–2009: a nationwide cohort study (CVDNOR)

Authors: Kjersti S. Rabanal, Randi M. Selmer, Jannicke Igland, Grethe S. Tell, Haakon E. Meyer

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Immigrants to Norway from South Asia and Former Yugoslavia have high levels of cardiovascular disease (CVD) risk factors. Yet, the incidence of CVD among immigrants in Norway has never been studied. Our aim was to study the burden of acute myocardial infarction (AMI) and stroke among ethnic groups in Norway.

Methods

We studied the whole Norwegian population (n = 2 637 057) aged 35–64 years during 1994–2009. The Cardiovascular Disease in Norway (CVDNOR) project provided information about all AMI and stroke hospital stays for this period, as well as deaths outside hospital through linkage to the Cause of Death Registry. The direct standardization method was used to estimate age standardized AMI and stroke event rates for immigrants and ethnic Norwegians. Rate ratios (RR) with ethnic Norwegians as reference were calculated using Poisson regression.

Results

The highest risk of AMI was seen in South Asians (men RR = 2.27; 95 % CI 2.08–2.49; women RR = 2.10; 95 % CI 1.76–2.51) while the lowest was seen in East Asians (RR = 0.38 in both men (95 % CI 0.25–0.58) and women (95 % CI 0.18–0.79)). Immigrants from Former Yugoslavia and Central Asia also had increased risk of AMI compared to ethnic Norwegians. South Asians had increased risk of stroke (men RR = 1.26; 95 % CI 1.10–1.44; women RR = 1.58; 95 % CI 1.32–1.90), as did men from Former Yugoslavia, Sub-Saharan Africa and women from Southeast Asia.

Conclusions

Preventive measures should be aimed at reducing the excess numbers of CVD among immigrants from South Asia and Former Yugoslavia.
Appendix
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Literature
1.
Albertinelli A, Knauth B, Kraszewska K, Thorogood D. Migrants in Europe: a statistical portrait of the first and second generation. Eurostat statistical books. Luxembourg: Publications Office of the European Union; 2011. ISBN 978-92-79-16231-2.
2.
Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M. Migration and health in an increasingly diverse Europe. Lancet. 2013;381(9873):1235–45.CrossRefPubMed
3.
4.
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(2):72–115.CrossRefPubMedPubMedCentral
5.
Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R. Mortality from all causes and circulatory disease by country of birth in England and Wales 2001–2003. J Public Health (Oxf). 2007;29(2):191–8.CrossRef
6.
Hempler NF, Larsen FB, Nielsen SS, Diderichsen F, Andreasen AH, Jorgensen T. A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role? BMC Public Health. 2011;11:662.CrossRefPubMedPubMedCentral
7.
Tillin T, Hughes AD, Mayet J, Whincup P, Sattar N, Forouhi NG, et al. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, south Asians, and African Caribbeans: SABRE (southall and Brent revisited)—A prospective population-based study. J Am Coll Cardiol. 2013;61(17):1777–86.CrossRefPubMedPubMedCentral
8.
Hedlund E, Lange A, Hammar N. Acute myocardial infarction incidence in immigrants to Sweden. Country of birth, time since immigration, and time trends over 20 years. Eur J Epidemiol. 2007;22(8):493–503.CrossRefPubMed
9.
Lee J, Heng D, Chia KS, Chew SK, Tan BY, Hughes K. Risk factors and incident coronary heart disease in Chinese, Malay and Asian Indian males: the Singapore cardiovascular cohort study. Int J Epidemiol. 2001;30(5):983–8.CrossRefPubMed
10.
Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, 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(9226):279–84.CrossRefPubMed
11.
Tillin T, Forouhi N, Johnston DG, McKeigue PM, Chaturvedi N, Godsland IF. Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study. Diabetologia. 2005;48(4):649–56.CrossRefPubMed
12.
Hjellset VT, Bjorge B, Eriksen HR, Hostmark AT. Risk factors for type 2 diabetes among female Pakistani immigrants: the InvaDiab-DEPLAN study on Pakistani immigrant women living in Oslo, Norway. J Immigr Minor Health. 2011;13(1):101–10.CrossRefPubMed
13.
Kumar B, Meyer H, Wandel M, Dalen I, Holmboe-Ottesen G. Ethnic differences in obesity among immigrants from developing countries, in Oslo, Norway. Int J Obes. 2006;30:684–90.CrossRef
14.
Yang D, Dzayee DA, Beiki O, de Faire U, Alfredsson L, Moradi T. Incidence and case fatality after day 28 of first time myocardial infarction in Sweden 1987–2008. Eur J Prev Cardiol. 2012;19(6):1304–15.CrossRefPubMed
15.
Bo A, Zinckernagel L, Krasnik A, Petersen JH, Norredam M. Coronary heart disease incidence among non-Western immigrants compared to Danish-born people: effect of country of birth, migrant status, and income. Eur J Prev Cardiol. 2014. doi:10.​1177/​2047487314551538​.
16.
Rabanal KS, Lindman AS, Selmer RM, Aamodt G. Ethnic differences in risk factors and total risk of cardiovascular disease based on the Norwegian CONOR study. Eur J Prev Cardiol. 2013;20(6):1013–21.CrossRefPubMed
17.
Igland J, Tell S, Ebbing M, Nygård O, Vollset S, Dimoski T. CVDNOR data and quality report: the CVDNOR project: cardiovascular disease in Norway 1994–2009. 2013. Description of data and data quality.
18.
Sulo G, Igland J, Vollset SE, Nygård O, Øyen N, Tell GS. Cardiovascular disease and diabetes mellitus in Norway during 1994–2009. Nor Epidemiol. 2013;23(1):101–7.
19.
Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJ, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. Geneva: World Health Organization; 2001.
20.
Rothman KJ, Greenland S, Lash TL. Modern epidemiology. Philadelphia: Lippincott Williams & Wilkins; 2008.
21.
Kumar B, Selmer R, Lindman A, Tverdal A, Falster K, Meyer H. Ethnic differences in SCORE cardiovascular risk in Oslo, Norway. Eur J Cardiovasc Prev Rehabil. 2009;16:229–34.CrossRefPubMed
22.
Glenday K, Kumar BN, Tverdal A, Meyer HE. Cardiovascular disease risk factors among five major ethnic groups in Oslo, Norway: the Oslo immigrant health study. Eur J Cardiovasc Prev Rehabil. 2006;13(3):348–55.CrossRefPubMed
23.
Fischbacher C, Bhopal R, Povey C, Steiner M, Chalmers J, Mueller G, et al. Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians. BMC Public Health. 2007;7(1):142.CrossRefPubMedPubMedCentral
24.
McKeigue PM, Miller G, Marmot M. Coronary heart disease in south Asians overseas: a review. J Clin Epidemiol. 1989;42(7):597–609.CrossRefPubMed
25.
Bhopal R, Bansal N, Fischbacher C, Brown H, Capewell S. Ethnic variations in the incidence and mortality of stroke in the Scottish Health and Ethnicity Linkage Study of 4.65 million people. Eur J Prev Cardiol. 2012;19(6):1503–8.CrossRefPubMed
26.
Gill PS, Kai J, Bhopal RS, Wild S. Black and minority ethnic groups. In: Stevens A, Raftery J, Mant J, Simpson S, editors. Health care needs assessment: the epidemiologically based needs assessment reviews. Abingdon: Radcliffe Medical Press; 2007. p. 227–399.
27.
28.
Henriksen K, Statistics Norway. Fakta om 18 innvandrergrupper i Norge. Reports 2007/29. 2007. Electronic version. ISBN 978-82-537-7222-6.
29.
Wentworth BA, Stein MB, Redwine LS, Xue Y, Taub PR, Clopton P, et al. Post-traumatic stress disorder: a fast track to premature cardiovascular disease? Cardiol Rev. 2013;21(1):16–22.CrossRefPubMed
30.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364(9438):937–52.CrossRefPubMed
31.
O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case–control study. Lancet. 2010;376(9735):112–23.CrossRefPubMed
32.
Domnich A, Panatto D, Gasparini R, Amicizia D. The “healthy immigrant” effect: does it exist in Europe today? Ital J Public Health. 2012;9(3):e7532-1–7.
33.
Moullan Y, Jusot F. Why is the ‘healthy immigrant effect’ different between European countries? Eur J Public Health. 2014;24 Suppl 1:80–6.CrossRefPubMed
34.
Høydahl E, editor. Innvandrere og norskfødte med innvandrerforeldre i 13 kommuner. 2014. (electronic): Statistics Norway. ISBN 978-82-537-8950-7.
35.
Turra CM, Elo IT. The impact of salmon bias on the Hispanic mortality advantage: New evidence from social security data. Popul Res Policy Rev. 2008;27(5):515–30.CrossRefPubMedPubMedCentral
36.
Norredam M, Hansen OH, Petersen JH, Kunst AE, Kristiansen M, Krasnik A, et al. Remigration of migrants with severe disease: myth or reality?-a register-based cohort study. Eur J Public Health. 2015;25(1):84–9.CrossRefPubMed
37.
Riosmena F, Wong R, Palloni A. Migration selection, protection, and acculturation in health: a binational perspective on older adults. Demography. 2013;50(3):1039–64.CrossRefPubMedPubMedCentral
38.
Sundquist J, Cmelic-Eng M, Johansson SE. Body mass index and distribution of body fat in female Bosnian refugees—a study in primary health care. Public Health. 1999;113(2):89–93.CrossRefPubMed
39.
Marques-Vidal P, Vollenweider P, Waeber G, Paccaud F. Prevalence of overweight and obesity among migrants in Switzerland: association with country of origin. Public Health Nutr. 2011;14(7):1148–56.CrossRefPubMed
40.
Grossmann FF, Leventhal ME, Auer-Boer B, Wanner P, Bischoff A. Self-reported cardiovascular risk factors in immigrants and Swiss nationals. Public Health Nurs. 2011;28(2):129–39.CrossRefPubMed
41.
Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, et al. European cardiovascular disease statistics 2012. Sophia Antipolis: European Heart Network, Brussels, European Society of Cardiology; 2012.
42.
Dilic M. Current data for CVD in Bosnia and Herzegovina and experience with Our Own guidelines. J Am Coll Cardiol. 2013;62(18_S2):C203.CrossRef
43.
Wiesbauer F, Blessberger H, Goliasch G, Holy EW, Pfaffenberger S, Tentzeris I, et al. Elevated risk of myocardial infarction in very young immigrants from former Yugoslavia. Eur J Epidemiol. 2009;24(11):691–6.CrossRefPubMed
44.
Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001;104(23):2855–64.CrossRefPubMed
45.
Gholap N, Davies M, Patel K, Sattar N, Khunti K. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes. 2011;5(1):45–56.CrossRefPubMed
46.
Zaman MJ, Bhopal RS. New answers to three questions on the epidemic of coronary mortality in south Asians: incidence or case fatality? Biology or environment? Will the next generation be affected? Heart. 2013;99(3):154–8.CrossRefPubMed
47.
Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746–53.CrossRefPubMed
48.
Bhopal R. Race and ethnicity: responsible use from epidemiological and public health perspectives. J Law Med Ethics. 2006;34(3):500–7.CrossRefPubMed
49.
Diaz E, Calderon-Larranaga A, Prado-Torres A, Poblador-Plou B, Gimeno-Feliu LA. How do immigrants use primary health care services? A register-based study in Norway. Eur J Public Health. 2015;25(1):72–8.CrossRefPubMed
50.
Nystadnes T. Identifikatorer for personer, syntaks for fødselsnummer, hjelpenummer mv. Versjon 1.0. KITH-standard 1001:2010 kompetansesenter for IT i helsevesenet AS. 2010.
51.
Joensen AM, Jensen MK, Overvad K, Dethlefsen C, Schmidt E, Rasmussen L, et al. Predictive values of acute coronary syndrome discharge diagnoses differed in the Danish national patient registry. J Clin Epidemiol. 2009;62(2):188–94.CrossRefPubMed
52.
Merry AH, Boer JA, Schouten L, Feskens EJM, Verschuren WMM, Gorgels APM, et al. Validity of coronary heart diseases and heart failure based on hospital discharge and mortality data in the Netherlands using the cardiovascular registry Maastricht cohort study. Eur J Epidemiol. 2009;24(5):237–47.CrossRefPubMed
53.
Madsen M, Davidsen M, Rasmussen S, Abildstrom SZ, Osler M. The validity of the diagnosis of acute myocardial infarction in routine statistics: a comparison of mortality and hospital discharge data with the Danish MONICA registry. J Clin Epidemiol. 2003;56(2):124–30.CrossRefPubMed
54.
Ellekjaer H, Holmen J, Kruger O, Terent A. Identification of incident stroke in Norway: hospital discharge data compared with a population-based stroke register. Stroke. 1999;30(1):56–60.CrossRefPubMed
55.
Indredavik B, Fjærtoft H, Ellekjær H, Skogseth-Stephani R, Mørch B. Norsk hjerneslagregister. Årsrapport 2013. Plan for forbedringstiltak. Nasjonalt sekretariat for Norsk hjerneslagregister, Seksjon for medisinske kvalitetsregistre. St. Olavs Hospital. 01.10.2014. Available at:www.​norskhjerneslagr​egister.​no. Accessed 16 Oct 2015.
Metadata
Title
Ethnic inequalities in acute myocardial infarction and stroke rates in Norway 1994–2009: a nationwide cohort study (CVDNOR)
Authors
Kjersti S. Rabanal
Randi M. Selmer
Jannicke Igland
Grethe S. Tell
Haakon E. Meyer
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2412-z

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