School of Population Health, University of Western Australia, Perth, Australia.
Eur J Prev Cardiol. 2012 Oct;19(5):983-90. doi: 10.1177/1741826711417925. Epub 2011 Jul 28.
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.
Historical cohort study.
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).
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.
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.
我们研究了 2000-04 年间非致命性首次心肌梗死患者的原住民身份与 2 年心血管疾病结局之间的关系，并对包括合并症在内的协变量进行了逐步调整。
历史队列研究。
使用人链接的医院和死亡率记录，确定 2000-04 年西澳大利亚州首次发生心肌梗死的 28 天幸存者，并进行 15 年的回溯。结局指标为：（1）心血管疾病死亡；（2）因心肌梗死再次入院；（3）（1）和（2）的复合结局。
与非原住民患者相比，原住民患者更年轻，更有可能居住在偏远地区。原住民患者有 5 年糖尿病和慢性肾脏病病史的比例是非原住民患者的两倍和三倍。单独调整人口统计学变量时，男性中原住民与非原住民发生心血管死亡或再次发生心肌梗死的风险比为 3.6（95%CI 2.5-5.3），女性为 4.5（95%CI 2.8-7.3）。在调整合并症（包括糖尿病、慢性肾脏病和心力衰竭）后，风险比分别下降 36%和 47%，男性和女性分别降至 2.3（1.6-3.0）和 2.4（1.5-4.0）。
原住民中合并症（包括糖尿病、肾脏病、心力衰竭和其他危险因素）的高患病率，极大地导致了原住民人群在心肌梗死后结局上的差异，这强调了在该人群中进行初级预防和全面管理慢性疾病的重要性。即使在调整合并症后，原住民身份仍然是疾病复发或死亡的一个重要独立危险因素，这表明需要采取社会层面的干预措施来解决社会劣势问题。
