Study objective: To examine the association of spatial variation in acute myocardial infarction (AMI) incidence and its putative environmental determinants in ground water such as total water hardness, the concentration of calcium, magnesium, fluoride, iron, copper, zinc, nitrate, and aluminium.
Design: Small area study using Bayesian modelling and the geo-referenced data aggregated into 10 km×10 km cells.
Setting: The population data were obtained from Statistics Finland, AMI case data from the National Death Register and the Hospital Discharge Register, and the geochemical data from hydrogeochemical database of Geological Survey of Finland.
Participants: A total of 18 946 men aged 35–74 years with the first AMI attack in the years 1983, 1988, and 1993.
Main results: One unit (in German degree °dH) increment in water hardness decreased the risk of AMI by 1%. Geochemical elements in ground water included in this study did not show a statistically significant effect on the incidence and spatial variation of AMI, even though suggestive findings were detected for fluoride (protective), iron and copper (increasing).
Conclusions: The results of this study with more specific Bayesian statistical analysis confirm findings from earlier observations of the inverse relation between water hardness and coronary heart disease. The role of environmental geochemistry in the geographical variation of the AMI incidence should be studied further in more detail incorporating the individual intake of both food borne and water borne nutrients. Geochemical-spatial analysis provides a basis for the selection of areas suitable for such research.
- Bayesian approach
- acute myocardial infarction
- ground water
- small area analysis
- CVD, cardiovascular disease
- AMI, acute myocardial infarction
- CHD, coronary heart disease
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Funding: this work was partly supported by Academy of Finland (no 78422), by the Yrjö Jansson Foundation and Juho Vainio Foundation.
Conflicts of interest: none declared.