Contributions of event rates, pre-hospital deaths, and deaths following hospitalisation to variations in myocardial infarction mortality in 326 districts in England: a spatial analysis of linked hospitalisation and mortality data.
Contributions of event rates, pre-hospital deaths, and deaths following hospitalisation to variations in myocardial infarction mortality in 326 districts in England: a spatial analysis of linked hospitalisation and mortality data.
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DOI：
10.1016/s2468-2667(22)00108-6
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发表时间：
2022-10
期刊：
影响因子：
--
通讯作者：
Ezzati M
中科院分区：
文献类型：
--
作者：
Asaria P;Bennett JE;Elliott P;Rashid T;Iyathooray Daby H;Douglass M;Francis DP;Fecht D;Ezzati M
高收入国家的心肌梗死死亡率差异很大。对于哪些干预措施（包括一级和二级预防，或改善护理途径和质量）可以降低心肌梗死死亡率的指导有限。我们的目的是了解发病率（事件率）、院前死亡和住院病死率对英格兰心肌梗死死亡率变化的影响。我们使用了2015年1月1日至2018年12月31日期间急性心肌梗死（ICD-10代码I21和I22）住院和死亡的国家数据库中的相关数据作为主要医院诊断或潜在死亡原因。我们使用地理标识符来估计心肌梗死事件发生率（每100 000人中的事件数），死亡率（每100 000人死亡人数），总病死率（导致死亡的事件比例），院前死亡（导致院前死亡的事件比例），以及英格兰326个地区45岁及以上男性和女性的住院病死率（入院后28天内因心肌梗死导致死亡的比例）。在贝叶斯空间模型中分析数据，该模型解释了致死性和非致死性心肌梗死空间模式的相似性和差异。通过对各年龄段的比率进行加权，并根据每项措施的相应国家份额的适当分母，计算出标准化比率。从2015年到2018年，全国年龄标准化死亡率为女性每10万人63人，男性每10万人126人，事件发生率为女性每10万人233人，男性每10万人512人。年龄标准化后，15.0%的女性和16.9%的男性事件导致住院前死亡，女性和男性的住院病死率分别为10.8%和10.6%。在各地区，年龄标准化心肌梗死死亡率的第99百分位数与第1百分位数之比在女性中为2.63（95%可信区间2.45 - 2.83），在男性中为2.56（2.37 - 2.76），其中英格兰北方部分地区的死亡率最高。造成这种变化的主要因素是心肌梗死事件发生率，各地区女性的第99百分位数与第1百分位数之比为2.55（2.39 - 2.72），男性为2.17（2.08 - 2.27）。各地区的院前病死率均高于住院病死率。院前死亡率的第99百分位数与第1百分位数之比为1.60（1·50-1·70）女性和1·75（1·66-1·86）在各地区的男性中，与住院病死率相比，对总病死率变化的贡献更大（第99百分位数与第1百分位数比值为1.39 [1.29 - 1.49]和1.49 [1.39 - 1.60]）。在55-64岁和65-74岁的妇女以及55-64岁、65 - 74岁和75-84岁的男子中，病死率对各区死亡率变化的贡献最大。在大多数地区和年龄组中，男性的院前死亡率略高于女性，而在几乎所有地区，65-74岁年龄段（包括65-74岁年龄段）的女性的院前死亡率较高。在英国，心肌梗死死亡率的变化大多是由于心肌梗死事件发生率的变化，病死率的作用较小。病死率的大多数变化发生在入院前而不是入院后。减少心肌梗死死亡率的地方差异需要降低事件发生率和院前死亡的干预措施。惠康信托基金会、英国心脏基金会、医学研究理事会（英国研究与创新）和国家健康研究所（英国）。
Myocardial infarction mortality varies substantially within high-income countries. There is limited guidance on what interventions—including primary and secondary prevention, or improvement of care pathways and quality—can reduce myocardial infarction mortality. Our aim was to understand the contributions of incidence (event rate), pre-hospital deaths, and hospital case fatality to the variations in myocardial infarction mortality within England. We used linked data from national databases on hospitalisations and deaths with acute myocardial infarction (ICD-10 codes I21 and I22) as a primary hospital diagnosis or underlying cause of death, from Jan 1, 2015, to Dec 31, 2018. We used geographical identifiers to estimate myocardial infarction event rate (number of events per 100 000 population), death rate (number of deaths per 100 000 population), total case fatality (proportion of events that resulted in death), pre-hospital fatality (proportion of events that resulted in pre-hospital death), and hospital case fatality (proportion of admissions due to myocardial infarction that resulted in death within 28 days of admission) for men and women aged 45 years and older across 326 districts in England. Data were analysed in a Bayesian spatial model that accounted for similarities and differences in spatial patterns of fatal and non-fatal myocardial infarction. Age-standardised rates were calculated by weighting age-specific rates by the corresponding national share of the appropriate denominator for each measure. From 2015 to 2018, national age-standardised death rates were 63 per 100 000 population in women and 126 per 100 000 in men, and event rates were 233 per 100 000 in women and 512 per 100 000 in men. After age-standardisation, 15·0% of events in women and 16·9% in men resulted in death before hospitalisation, and hospital case fatality was 10·8% in women and 10·6% in men. Across districts, the 99th-to-1st percentile ratio of age-standardised myocardial infarction death rates was 2·63 (95% credible interval 2·45–2·83) in women and 2·56 (2·37–2·76) in men, with death rates highest in parts of northern England. The main contributor to this variation was myocardial infarction event rate, with a 99th-to-1st percentile ratio of 2·55 (2·39–2·72) in women and 2·17 (2·08–2·27) in men across districts. Pre-hospital fatality was greater than hospital case fatality in every district. Pre-hospital fatality had a 99th-to-1st percentile ratio of 1·60 (1·50–1·70) in women and 1·75 (1·66–1·86) in men across districts, and made a greater contribution to variation in total case fatality than did hospital case fatality (99th-to-1st percentile ratio 1·39 [1·29–1·49] and 1·49 [1·39–1·60]). The contribution of case fatality to variation in deaths across districts was largest in women aged 55–64 and 65–74 years and in men aged 55–64, 65–74, and 75–84 years. Pre-hospital fatality was slightly higher in men than in women in most districts and age groups, whereas hospital case fatality was higher in women in virtually all districts at ages up to and including 65–74 years. Most of the variation in myocardial infarction mortality in England is due to variation in myocardial infarction event rate, with a smaller role for case fatality. Most variation in case fatality occurs before rather than after hospital admission. Reducing subnational variations in myocardial infarction mortality requires interventions that reduce event rate and pre-hospital deaths. Wellcome Trust, British Heart Foundation, Medical Research Council (UK Research and Innovation), and National Institute for Health Research (UK).
法国急性心肌梗塞一年后，空间分布的空间分布。
影响因子：
4.1
作者：
Piccard M;Roussot A;Cottenet J;Cottin Y;Zeller M;Quantin C
通讯作者：
Quantin C