Geographical clustering of incident acute myocardial infarction in Denmark: A spatial analysis approach

OBJECTIVES: To examine the geographical patterns in AMI and characterize individual and neighborhood sociodemographic factors for persons living inside versus outside AMI clusters. METHODS: The study population comprised 3,515,670 adults out of whom 74,126 persons experienced an incident AMI (2005-2011). Kernel density estimation and global and local clustering methods were used to examine the geographical patterns in AMI. Median differences and frequency distributions of sociodemographic factors were calculated for persons living inside versus outside AMI clusters. RESULTS: Global clustering of AMI occurred in Denmark. Throughout the country, 112 significant clusters with high risk of incident AMI were identified. The relative risk of AMI in significant clusters ranged from 1.45 to 47.43 (median=4.84). Individual and neighborhood socioeconomic position was markedly lower for persons living inside versus outside AMI clusters. CONCLUSIONS: AMI is geographically unequally distributed throughout Denmark and determinants of these geographical patterns might include individual- and neighborhood-level sociodemographic factors.