TY - JOUR
T1 - Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia
T2 - A multilevel data linkage study
AU - Randall, Deborah A.
AU - Jorm, Louisa R.
AU - Lujic, Sanja
AU - Oloughlin, Aiden J.
AU - Churches, Timothy R.
AU - Haines, Mary
AU - Eades, Sandra J.
AU - Leyland, Alastair H.
PY - 2012
Y1 - 2012
N2 - 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 25-84years 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 365days (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.
AB - 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 25-84years 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 365days (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.
KW - Aboriginal health
KW - Acute myocardial infarction
KW - Data linkage
KW - Health outcomes
KW - Hospital performance
KW - Ischaemic heart disease
KW - Multilevel modelling
UR - http://www.scopus.com/inward/record.url?scp=84862184910&partnerID=8YFLogxK
U2 - 10.1186/1471-2458-12-281
DO - 10.1186/1471-2458-12-281
M3 - Article
C2 - 22490109
AN - SCOPUS:84862184910
SN - 1471-2458
VL - 12
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 281
ER -