S. Capewell et al., Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986-95: a retrospective cohort study, LANCET, 358(9289), 2001, pp. 1213-1217
Citations number
33
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background Most deaths from coronary heart disease occur out of hospital. H
ospital patients face social, age, and sex inequalities. Our aim was to exa
mine inequalities and trends in out-of-hospital cardiac deaths.
Methods We used the Scottish record linked database to identify all deaths
from acute myocardial infarction that occurred in Scotland (population 5.1
million), in 1986-95. We have compared population-based death rates for men
and women across age and social groups.
Findings Between 1986 and 1995, 83 365 people died from acute myocardial in
farction, out of hospital and without previous hospital admission (44 655 m
en, 38 710 women); and 117 749 were admitted with a first acute myocardial
infarction, of whom 37 020 died within 1 year. Thus, out-of-hospital deaths
accounted for 69.2% (95% CI 69.0-69.5) of all 120 385 deaths. Out-of-hospi
tal deaths, measured as a proportion of all acute myocardial infarction eve
nts (deaths plus first hospital admissions), increased with age, from 20.1%
(19.2-21.0) in people younger than 55 years, to 62.1% (61.3-62.9) in those
older than 85 years. Population-based out-of-hospital mortality rates fell
by a third in men and by a quarter in women. Mean yearly falls were larger
in people aged 55-64 years (5.6% per year in men, 3.7% in women), than in
those older than 85 years (2.5% in men and women), Mortality rates were sub
stantially higher in deprived socioeconomic groups than in affluent groups,
especially in people younger than 65 years.
Interpretation These inequalities in age, sex, and socioeconomic class shou
ld be actively addressed by prevention strategies for coronary heart diseas
e.