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Chronic disease
P2-21 Ethnic inequalities in myocardial infarction incidence, interventions and survival in Scotland: the Scottish Health and Ethnicity Linkage Study (SHELS)
  1. N Bansal1,
  2. C Fischbacher2,
  3. R Bhopal1,
  4. H Brown1,
  5. M Steiner1,
  6. S Capewell3
  1. 1University of Edinburgh, Edinburgh, UK
  2. 2Information Services Division, Edinburgh, UK
  3. 3University of Liverpool, Liverpool, UK

Abstract

Introduction Ethnic variations in coronary heart disease are large with a 50–70% excess consistently observed in South Asians. It is not clear whether this is attributable to increased incidence, poor survival, or both. We compared incidence and outcome of first acute myocardial infarction (AMI) by ethnic group in Scotland in relation to cardiac intervention uptake, socioeconomic factors and proximity to hospital.

Methods We used linkage methods to combine ethnicity data from those aged ≥30 years of age in the 2001 Scottish Census with records of subsequent hospital discharges and deaths between 1 May 2001 and 30 April 2008. We compared incidence (death or discharge) and case fatality following first AMI by ethnic group using the White Scottish as the standard comparison population.

Results AMI incidence rates were highest among Pakistani and lowest for Chinese, Other White British and Other White ethnic groups. Adjustment for highest educational qualification attenuated differences between White Scottish and other White groups but did not fully explain the excess in the Pakistani group. Pakistani women had lower HRs for death after AMI partly explained by shorter travel time to hospital. We found no evidence for lower uptake of cardiovascular procedures in Indians and Pakistanis.

Conclusions The known elevated coronary heart disease risk in South Asians principally reflects increased incidence in Pakistanis emphasising the need for aggressive management of modifiable cardiovascular risk factors. Pakistani women were protected from case fatality in part by their closer proximity to hospital and not increased uptake of interventional procedures.

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