Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Nobels väg 13,Stockholm, Sweden.
Eur J Prev Cardiol. 2012 Dec;19(6):1304-15. doi: 10.1177/1741826711425340. Epub 2011 Sep 30.
We studied trends in first-time myocardial infarction (MI) incidence and case fatality after day 28 and to examine the role of sex, education as an indicator for socioeconomic position, and birth country on these events in Sweden.
Nationwide cohort including 6,752,655 individuals aged 35-89 years living in Sweden between January 1987 and December 2008, of which, 6,464,968 individuals and 366,085 nonfatal first-time MI patients were classified according to their sex, birth country, and education and followed over two decades.
Incidence and case-fatality rate after day 28 of first-time MI and their trends. A decreasing trend for first-time MI incidence and case fatality after day 28 for both sexes regardless of birth country was observed (p-trend<0.0001). The trend was, however, less pronounced among female and foreign-born. Men had higher incidence than women (incidence rate ratio, IRR 2.09, 95% CI 2.08-2.11). Men born in Southern and Western Asia had 50% (95% CI 40-60%) higher risk than men born in Sweden. Incidence was 50-80% higher in the least educated irrespective of sex and birth country (p-trend<0.0001). This association was stronger for female and foreign-born. We observed a 15% higher case fatality after day 28 among men than women (hazard ratio, HR 1.15, 95% CI 1.13-1.17) and 20-40% lower case fatality after day 28 among patients with no diabetes. Low education was associated with 50% higher case fatality after day 28 regardless of sex and birth country (p-trend <0.0001).
Although incidence of, and fatality after, first-time MI continued to decrease, low socioeconomic position, independent of birth country and sex, remained an important risk indicator for both events.
我们研究了首次心肌梗死（MI）发病后 28 天的发病趋势和病死率，并探讨了性别、教育（作为社会经济地位的指标）以及出生国对这些事件的影响。
本研究为全国性队列研究，纳入了 1987 年 1 月至 2008 年 12 月期间居住在瑞典的 35-89 岁的 6752655 名个体，其中 6464968 名个体和 366085 例非致命性首次 MI 患者根据性别、出生国和教育进行分类，并随访了二十多年。
首次 MI 发病后 28 天的发病率和病死率及其趋势。结果显示，无论出生国如何，两性的首次 MI 发病率和发病后 28 天病死率均呈下降趋势（趋势检验 P<0.0001）。但这一趋势在女性和外国出生者中不太明显。男性的发病率高于女性（发病率比 2.09，95%置信区间 2.08-2.11）。出生于南亚和西亚的男性发病风险比出生于瑞典的男性高 50%（95%置信区间 40-60%）。无论性别和出生国如何，教育程度最低者的发病率均高 50-80%（趋势检验 P<0.0001）。这种关联在女性和外国出生者中更强。我们发现，男性发病后 28 天的病死率比女性高 15%（危险比 1.15，95%置信区间 1.13-1.17），而无糖尿病患者的病死率则低 20-40%。低教育程度与发病后 28 天的病死率增加 50%相关，无论性别和出生国如何（趋势检验 P<0.0001）。
尽管首次 MI 的发病率和病死率持续下降，但低社会经济地位（独立于出生国和性别）仍是这两个事件的重要危险因素。
