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Type: Journal article
Title: Aboriginal to non-Aboriginal differentials in 2-year outcomes following non-fatal first-ever acute MI persist after adjustment for comorbidity
Author: Katzenellenbogen, J.
Sanfilippo, F.
Hobbs, M.
Briffa, T.
Ridout, S.
Knuiman, M.
Dimer, L.
Taylor, K.
Thompson, P.
Thompson, S.
Citation: European Journal of Cardiovascular Prevention and Rehabilitation, 2012; 19(5):983-990
Publisher: SAGE Publications
Issue Date: 2012
ISSN: 2047-4873
Statement of
Judith M Katzenellenbogen, Frank M Sanfilippo, Michael ST Hobbs, Tom G Briffa, Steve C Ridout, Matthew W Knuiman, Lyn Dimer, Kate P Taylor, Peter L Thompson, and Sandra C Thompson
Abstract: Background: We investigated the relationship between Aboriginality and 2-year cardiovascular disease outcomes in non-fatal first-ever myocardial infarction during 2000-04, with progressive adjustment of covariates, including comorbidities. Design: Historical cohort study. METHODS: Person-linked hospital and mortality records were used to identify 28-day survivors of first-ever myocardial infarction in Western Australia during 2000-04 with 15-year lookback. The outcome measures were: (1) cardiovascular disease death; (2) recurrent admission for myocardial infarction; and (3) the composite of (1) and (2). Results: Compared with non-Aboriginal patients, Aboriginals were younger and more likely to live remotely. The proportions having 5-year histories of diabetes and chronic kidney disease were double and triple those of non-Aboriginals. When adjusting for demographic variables alone, the Aboriginal to non-Aboriginal hazard ratios for cardiovascular death or recurrent myocardial infarction were 3.6 (95% CI 2.5-5.3) in men and 4.5 (95% CI 2.8-7.3) in women. After adjustment for comorbidities, including diabetes, chronic kidney disease and heart failure, the hazard ratios decreased 36% and 47% to 2.3 (1.6-3.0) and 2.4 (1.5-4.0) in males and females, respectively. Conclusions: The high prevalence of comorbidities in Aboriginal people, including diabetes, kidney disease, heart failure, and other risk factors contribute substantially to the disparity in post-myocardial infarction outcomes in Aboriginal people, reinforcing the importance of both primary prevention and comprehensive management of chronic conditions in this population. Aboriginality remains a significant independent risk factor for disease recurrence or mortality, even after adjusting for comorbidity, suggesting the need for society-level interventions addressing social disadvantage.
Keywords: Aboriginal; cardiovascular outcomes; myocardial infarction; social differentials
Rights: © The European Society of Cardiology 2011. Reprints and permissions:
DOI: 10.1177/1741826711417925
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