Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

BMC Public Health

Alastair H Leyland²  Sandra J Eades³  Mary M Haines¹  Timothy R Churches¹  Aiden J O’Loughlin⁴  Sanja Lujic⁴  Louisa R Jorm¹  Deborah A Randall⁴ 

[1] The Sax Institute, Quay Street, Sydney, NSW, Australia;Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Lilybank Gardens, Glasgow, UK;Baker IDI Heart and Diabetes Institute, Commercial Road, Melbourne, Victoria, Australia;School of Medicine, University of Western Sydney, Narellan Road, Campbelltown, NSW, Australia

关键词: Data linkage;    Multilevel modelling;    Health outcomes;    Aboriginal health;    Ischaemic heart disease;    Acute myocardial infarction;    Hospital performance;   

Others  :  1163694
DOI  :  10.1186/1471-2458-12-281

 received in 2011-10-17, accepted in 2012-04-03,  发布年份 2012

【 摘 要 】

Background

Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes.

Methods

Admission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality.

Results

Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status.

Conclusions

Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people.

【 授权许可】

   
2012 Randall et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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