Geographical inequalities in acute myocardial infarction beyond neighbourhood-level and individuallevel sociodemographic characteristics: a Danish 10-year nationwide population-based cohort study
Geographical inequalities in acute myocardial infarction beyond neighbourhood-level and individuallevel sociodemographic characteristics: a Danish 10-year nationwide population-based cohort study
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DOI：
10.1136/bmjopen-2018-024207
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Ersboll, Annette Kjaer
中科院分区：
文献类型：
--
作者：
Kjaerulff, Thora Majlund;Bihrmann, Kristine;Ersboll, Annette Kjaer
目的探讨社区水平和个人水平的社会人口学特征是否能解释急性心肌梗死(AMI)发病的地理分布模式。设计采用开放式队列研究设计，研究对象为2005-2014年间在丹麦居住的无急性心肌梗死成年人(年龄=30岁)，基于唯一的个人身份号码链接的全国行政人口和健康登记数据。使用贝叶斯方法对具有地理随机效应成分的急性心肌梗死发病率(IRS)进行泊松回归。分析包括收入、种族构成、人口密度和人口流动等社区层面的变量，并考虑了个人层面的年龄、性别、日历年、同居状态、收入和教育。设定在丹麦的居民(2005-2014)。参与研究的人群包括4128 079人(33 907 796人年)，其中98 265人经历过急性心肌梗死事件。结果显示，模型中包括个人和社区社会人口特征，减少了急性心肌梗死事件的IRS。然而，在调整后的模型中，居住在某些地区与急性心肌梗死的IRS值增加高达40%相关，考虑到社会人口学特征仅适度改变了地理疾病模式。结论社区和个人的社会人口学特征的差异可以部分解释急性心肌梗死发病的地理不平等，但不是全部。预防战略应解决急性心肌梗死事件中确认的社会不平等问题，但也应针对疾病负担较重的地区，以便能够有效地分配预防资源。
Objective This study examined whether geographical patterns in incident acute myocardial infarction (AMI) were explained by neighbourhood-level and individual-level sociodemographic characteristics.Design An 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.Setting Residents in Denmark (2005-2014).Participants The study population included 4 128 079 persons (33 907 796 person-years at risk) out of whom 98 265 experienced an incident AMI.Outcome measure Incident AMI registered in the National Patient Register or the Register of Causes of Death.Results Including 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.Conclusions Differences 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.