Key result
Aboriginal status linked to ~34% higher 1-year post-MI mortality, largely explained by comorbidity burden.
Why the study?
Heart disease is a leading cause of the burden of disease gap between Aboriginal and non-Aboriginal Australians, but disparities in mortality after AMI admission and hospital impact on outcomes were not well studied in NSW.
Cohort (n=60,047)
Yes
Odds Ratio: 1.34 (95% CI 1.1–1.63)
Absolute Event Rate: 10.7% vs 15.2%
p-value: p=0.003
Comorbidities largely explain excess 365-day post-MI mortality in Aboriginal patients; leaves open whether targeted interventions can further narrow gaps.
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.
No takes yet. Share an insight, caveat, or question.
Randall et al. (2012) conducted a cohort in Acute myocardial infarction (n=60,047). Aboriginal status vs. Non-Aboriginal status was evaluated on 365-day all-cause mortality (adjusted for age, sex, year of admission, and hospital) (AOR 1.34, 95% CI 1.10-1.63, p=0.003). Aboriginal patients admitted with acute myocardial infarction had a significantly higher risk of 365-day mortality compared to non-Aboriginal patients (AOR 1.34), though this difference was largely explained by a higher comorbidity burden.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: