Geographical inequalities in acute myocardial infarction beyond neighbourhood-level and individual-level sociodemographic characteristics: a Danish 10-year nationwide population-based cohort study

Abstract

ObjectiveThis study examined whether geographical patterns in incident acute myocardial infarction (AMI) were explained by neighbourhood-level and individual-level sociodemographic characteristics.DesignAn open cohort study design of AMI-free adults (age ≥30 years) with a residential location in Denmark in 2005–2014 was used based on nationwide administrative population and health register data linked by the unique personal identification number. Poisson regression of AMI incidence rates (IRs) with a geographical random effect component was performed using a Bayesian approach. The analysis included neighbourhood-level variables on income, ethnic composition, population density and population turnover and accounted for individual-level age, sex, calendar year, cohabitation status, income and education.SettingResidents in Denmark (2005–2014).ParticipantsThe study population included 4 128 079 persons (33 907 796 person-years at risk) out of whom 98 265 experienced an incident AMI.Outcome measureIncident AMI registered in the National Patient Register or the Register of Causes of Death.ResultsIncluding individual and neighbourhood sociodemographic characteristics in the model decreased the variation in IRs of AMI. However, living in certain areas was associated with up to 40% increased IRs of AMI in the adjusted model and accounting for sociodemographic characteristics only moderately changed the geographical disease patterns.ConclusionsDifferences in sociodemographic characteristics of the neighbourhood and individuals explained part, but not all of the geographical inequalities in incident AMI. Prevention strategies should address the confirmed social inequalities in incident AMI, but also target the areas with a heavy disease burden to enable efficient allocation of prevention resources.

Comprehensive analyses of geographical inequalities in cardiovascular disease incidence and survival: A possible aid to rationalize prevention strategies

“…The median parish population size in Denmark in 2014 was 1038 (range 25-43,052) and the median parish area was 16.2 km 2 (range 0.1-114.8 km 2 ). 2 Kjaerulff et al 1 reported weak correlations between parish-level and individual-level sociodemographic variables. 2 Such correlations would be stronger if the parishes were replaced by smaller neighbourhoods that were more homogenous with regard to social deprivation.…”

“…They have previously published an analogous study on the incidence of AMI in the same setting. 2 We acknowledge that studies of geographical inequalities in cardiovascular disease (CVD) incidence and survival are challenging. Nevertheless, such studies can help to target areas with a heavy CVD burden and/ or an unfavourable mortality rate among incident cases, which, in turn, may enable the rational allocation of prevention resources.…”

“…They considered four dimensions of the neighbourhood sociodemographic environment in which people live: neighbourhood socioeconomic position; ethnic composition; population density; and population turnover. 1,2,5 A key feature of their analyses was the assessment of geographical variation beyond the neighbourhood-level and individual-level sociodemographic characteristics. 1,2 However, geographically linked data on factors reflecting accessibility to healthcare and EMS were lacking.…”

“…1,2,5 A key feature of their analyses was the assessment of geographical variation beyond the neighbourhood-level and individual-level sociodemographic characteristics. 1,2 However, geographically linked data on factors reflecting accessibility to healthcare and EMS were lacking. Basic information about the geographical locations of relevant services may provide further insights.…”

“…Another concern is whether parish-level data are adequate for providing informative estimates reflecting the influence of neighbourhood characteristics. The median parish population size in Denmark in 2014 was 1038 (range 25–43,052) and the median parish area was 16.2 km 2 (range 0.1–114.8 km 2 ). 2 Kjærulff et al.…”