Myocardial infarction in an urban population - Studies on patterns of disease in terms of time, place and person

Sammanfattning: 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.