You Jiqiong, Condon John R, Zhao Yuejen, Guthridge Steven
Health Gains Planning, Department of Health and Community Services, Darwin, NT, Australia.
Med J Aust. 2009 Mar 16;190(6):298-302. doi: 10.5694/j.1326-5377.2009.tb02416.x.
To estimate the incidence and survival rates of acute myocardial infarction (AMI) for Northern Territory Indigenous and non-Indigenous populations.
Retrospective cohort study for all new AMI cases recorded in hospital inpatient data or registered as an ischaemic heart disease (IHD) death between 1992 and 2004.
Population-based incidence and survival rates by age, sex, Indigenous status, remoteness of residence and year of diagnosis.
Over the 13-year study period, the incidence of AMI increased 60% in the NT Indigenous population (incidence rate ratio [IRR], 1.04; 95% CI, 1.02-1.06), but decreased 20% in the non-Indigenous population (IRR, 0.98; 95% CI, 0.97-1.00). Over the same period, there was an improvement in all-cases survival (ie, survival with and without hospital admission) for the NT Indigenous population due to a reduction in deaths both pre-hospital and after hospital admission (death rates reduced by 56% and 50%, respectively). The non-Indigenous all-cases death rate was reduced by 29% as a consequence of improved survival after hospital admission; there was no significant change in pre-hospital survival in this population. Important factors that affected outcome in all people after AMI were sex (better survival for women), age (survival declined with increasing age), remoteness (worse outcomes for non-Indigenous residents of remote areas), year of diagnosis and Indigenous status (hazard ratio, 1.44; 95% CI, 1.21-1.70).
Our results show that the increasing IHD mortality in the NT Indigenous population is a consequence of a rise in AMI incidence, while at the same time there has been some improvement in Indigenous AMI survival rates. The simultaneous decrease in IHD mortality in NT non-Indigenous people was a result of reduced AMI incidence and improved survival after AMI in those admitted to hospital. Our results inform population-specific strategies for a systemwide response to AMI management.
估算北领地原住民和非原住民人群急性心肌梗死（AMI）的发病率及生存率。
对1992年至2004年间医院住院数据中记录的所有新发AMI病例或登记为缺血性心脏病（IHD）死亡病例进行回顾性队列研究。
按年龄、性别、原住民身份、居住偏远程度及诊断年份划分的基于人群的发病率和生存率。
在为期13年的研究期间，北领地原住民人群中AMI的发病率增加了60%（发病率比[IRR]为1.04；95%置信区间为1.02 - 1.06），而非原住民人群中的发病率下降了20%（IRR为0.98；95%置信区间为0.97 - 1.00）。在同一时期，北领地原住民人群的全病例生存率（即入院和未入院的生存情况）有所改善，这是由于院前和入院后死亡人数减少（死亡率分别降低了56%和50%）。非原住民全病例死亡率因入院后生存率提高而降低了29%；该人群的院前生存率无显著变化。AMI后影响所有人预后的重要因素包括性别（女性生存率更高）、年龄（生存率随年龄增长而下降）、偏远程度（偏远地区的非原住民居民预后更差）、诊断年份及原住民身份（风险比为1.44；95%置信区间为1.21 - 1.70）。
我们的结果表明，北领地原住民人群中IHD死亡率上升是AMI发病率上升的结果，与此同时，原住民AMI生存率有所改善。北领地非原住民人群中IHD死亡率的同时下降是AMI发病率降低以及入院患者AMI后生存率提高的结果。我们的结果为针对AMI管理的全系统应对措施提供了针对特定人群的策略依据。
