Abstract
Malmö (pop. 250 000) is a city in the south of Sweden where there are marked intra-urban differences in the mortality rates from myocardial infarction. This thesis, which is based on local and national morbidity and mortality registers and two prospective population-based cohort studies, should be considered as an attempt to explore if and how morbidity and mortality patterns co-vary with the prevalence of major risk factors and to assess the extent to which intra-urban differences in mortality are related to incidence respectively rates of survival.
About 70% of the variance in mortality between Malmö's residential areas was explained by the variance in incidence. During the period 1986-1992 there was a parallel decline in mortality and incidence, although there were substantial variations in terms of age and sex. The geographical pattern of disease was related to the prevalence of major atherosclerotic risk factors and to the socio-economic circumstances in the residential areas.
Differences in terms of outcome out-of-hospital significantly contributed to the geographical pattern of mortality. Patients from areas with inferior socio-economic circumstances had the least favourable outcome. The immediate and 28 days case fatality rate following a first myocardial infarction was related to the number and the type of atherosclerotic and psychosocial risk factors the patients had been exposed to.
Differences in terms of long-term survival following hospital discharge after a first myocardial infarction significantly contributed to the geographical pattern of mortality. Patients from residential areas with inferior socio-economic circumstances and a high prevalence of major cardiovascular risk factors had the least favourable prognosis.
It is concluded that the intra-urban variance in mortality rates from myocardial infarction is related to both incidence and survival rates. Inferior socio-economic circumstances in a residential area were associated with a high prevalence of cardiovascular risk factors, an increased incidence of myocardial infarction, an increased acute case fatality rate and with a less favourable long-term prognosis.
About 70% of the variance in mortality between Malmö's residential areas was explained by the variance in incidence. During the period 1986-1992 there was a parallel decline in mortality and incidence, although there were substantial variations in terms of age and sex. The geographical pattern of disease was related to the prevalence of major atherosclerotic risk factors and to the socio-economic circumstances in the residential areas.
Differences in terms of outcome out-of-hospital significantly contributed to the geographical pattern of mortality. Patients from areas with inferior socio-economic circumstances had the least favourable outcome. The immediate and 28 days case fatality rate following a first myocardial infarction was related to the number and the type of atherosclerotic and psychosocial risk factors the patients had been exposed to.
Differences in terms of long-term survival following hospital discharge after a first myocardial infarction significantly contributed to the geographical pattern of mortality. Patients from residential areas with inferior socio-economic circumstances and a high prevalence of major cardiovascular risk factors had the least favourable prognosis.
It is concluded that the intra-urban variance in mortality rates from myocardial infarction is related to both incidence and survival rates. Inferior socio-economic circumstances in a residential area were associated with a high prevalence of cardiovascular risk factors, an increased incidence of myocardial infarction, an increased acute case fatality rate and with a less favourable long-term prognosis.
| Original language | English |
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| Qualification | Doctor |
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| Award date | 2002 Dec 19 |
| Publisher | |
| ISBN (Print) | 91-628-5451-8 |
| Publication status | Published - 2002 |
Bibliographical note
Defence detailsDate: 2002-12-19
Time: 10:15
Place: Jubileumsaulan, MFC, UMAS, Malmö
External reviewer(s)
Name: Rosengren, Annika
Title: Prof
Affiliation: Göteborg University
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Article: I Tydén P, Hansen O, Janzon L. Intra-urban variations in incidence and mortality in myocardial infarction - A study from the myocardial infarction register in the city of Malmö, Sweden. European Heart Journal 1998; 19: 1795-1801.
Article: II Engström G, Berglund G, Göransson M, Hansen O, Hedblad B, Merlo J, Tydén P, Janzon L. Distribution and determinants of ischaemic heart disease in an urban population - A study from the myocardial infarction register in Malmö, Sweden. Journal of Internal Medicine 2000; 247: 588-596.
Article: III Tydén P, Engström G, Hansen O, Hedblad B, Janzon L. Geographical pattern of female deaths from myocardial infarction in an urban population: fatal outcome out-of-hospital related to socio-economic deprivation. Journal of Internal Medicine 2001; 250: 201-207
Article: IV Tydén P, Engström G, Berglund G, Hansen O, Hedblad B, Janzon L. Cardiovascular risk factors as determinants of immediate and 28 days case fatality rate following first myocardial infarction - A study from the Malmö Preventive Project. Submitted for publication.
Article: V Tydén P, Hansen O, Engström G, Hedblad B, Janzon L. Myocardial infarction in an urban population: worse long term prognosis for patients from less-affluent residential areas. Journal of Epidemiology and Community Health 2002; 56: 785-790.
Subject classification (UKÄ)
- Cardiology and Cardiovascular Disease
Free keywords
- epidemiologi
- demography
- Public health
- epidemiology
- Folkhälsa
- psychosocial aspects
- socio-economic factors
- risk factors
- mortality
- survival rate
- case fatality rate
- incidence
- Myocardial infarction
- ischaemic heart disease
