Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: Roles of age, gender, geography and area-level disadvantage

• Published in: Health & place Vol. 28; pp. 58 - 66
• Main Authors: Randall, D.A., Jorm, L.R., Lujic, S., Eades, S.J., Churches, T.R., O’Loughlin, A.J., Leyland, A.H.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.07.2014; Elsevier
• Subjects: Aboriginal health; Aborigines; Accounting; Acute myocardial infarction; Adult; Age Distribution; Aged; Aged, 80 and over; Australia; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Data linkage; Environment. Living conditions; Female; Geography; Health inequality; Health Status Disparities; Health technology assessment; Heart; Hospitals; Humans; Male; Medical sciences; Middle Aged; Mortality; Multilevel modeling; Myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - ethnology; New South Wales; New South Wales - epidemiology; Oceanic Ancestry Group - statistics & numerical data; Poisson Distribution; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registries; Regression analysis; Rural Population - statistics & numerical data; Sex Distribution; Urban Population - statistics & numerical data; Australia; Oceania; New South Wales; Aboriginal health; Multilevel modeling; Acute myocardial infarction; Data linkage; Medical data; Geography; Myocardial infarction; Binding; Acute; Sex; Cardiovascular disease; Coronary heart disease; Myocardial disease; Modeling; Multilevel analysis; Disadvantage; Aboriginal; Disparity; Age; Public health
• ISSN: 1353-8292; 1873-2054
• DOI: 10.1016/j.healthplace.2014.03.009

We investigated disparities in rates of acute myocardial infarction (AMI) between Aboriginal and non-Aboriginal people in the 199 Statistical Local Areas (SLAs) in New South Wales, Australia. Using routinely collected and linked hospital and mortality data from 2002 to 2007, we developed multilevel Poisson regression models to estimate the relative rates of first AMI events in the study period accounting for area of residence. Rates of AMI in Aboriginal people were more than two times that in non-Aboriginal people, with the disparity greatest in more disadvantaged and remote areas. AMI rates in Aboriginal people varied significantly by SLA, as did the Aboriginal to non-Aboriginal rate ratio. We identified almost 30 priority areas for universal and targeted preventive interventions that had both high rates of AMI for Aboriginal people and large disparities in rates. •Rates of AMI events for Aboriginal people were two times that for non-Aboriginal people.•Relative disparity was greater in younger age groups and women.•Relative disparity was greater in more disadvantaged areas.•“High rate, high disparity” areas are priorities for intervention.