Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986-95: A retrospective cohort study

Simon Capewell, Kate MacIntyre, Simon Stewart, Jim W.T. Chalmers, James Boyd, Alan Finlayson, Adam Redpath, Jill P. Pell, John J.V. McMurray

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Abstract

Background: Most deaths from coronary heart disease occur out of hospital. Hospital patients face social, age, and sex inequalities. Our aim was to examine inequalities and trends in out-of-hospital cardiac deaths. Methods: We used the Scottish record linked database to identify all deaths from acute myocardial infarction that occurred in Scotland (population 5.1 million), in 1986-95. We have compared population-based death rates for men and women across age and social groups. Findings: Between 1986 and 1995, 83 365 people died from acute myocardial infarction, out of hospital and without previous hospital admission (44 655 men, 38 710 women); and 117 749 were admitted with a first acute myocardial infarction, of whom 37 020 died within 1 year. Thus, out-of-hospital deaths accounted for 69.2% (95% CI 69.0-69.5) of all 120 385 deaths. Out-of-hospital deaths, measured as a proportion of all acute myocardial infarction events (deaths plus first hospital admissions), increased with age, from 20.1% (19.2-21.0) in people younger than 55 years, to 62.1% (61.3-62.9) in those older than 85 years. Population-based out-of-hospital mortality rates fell by a third in men and by a quarter in women. Mean yearly falls were larger in people aged 55-64 years (5.6% per year in men, 3.7% in women), than in those older than 85 years (2.5% in men and women). Mortality rates were substantially higher in deprived socioeconomic groups than in affluent groups, especially in people younger than 65 years. Interpretation: These inequalities in age, sex, and socioeconomic class should be actively addressed by prevention strategies for coronary heart disease.

Original languageEnglish
Pages (from-to)1213-1217
Number of pages5
JournalLancet
Volume358
Issue number9289
DOIs
Publication statusPublished - 13 Oct 2001
Externally publishedYes

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Capewell, S., MacIntyre, K., Stewart, S., Chalmers, J. W. T., Boyd, J., Finlayson, A., Redpath, A., Pell, J. P., & McMurray, J. J. V. (2001). Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986-95: A retrospective cohort study. Lancet, 358(9289), 1213-1217. https://doi.org/10.1016/S0140-6736(01)06343-7