Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study.
OBJECTIVE
To compare mortality in south Asian (Indian, Pakistani, and Bangladeshi) and white patients in the six months after hospital admission for acute myocardial infarction.


METHODS
Observational study.


METHODS
District general hospital in east London.


METHODS
149 south Asian and 313 white patients aged < 65 years admitted to the coronary care unit with acute myocardial infarction from 1 December 1988 to 31 December 1992.


METHODS
All cause mortality in the first six months after myocardial infarction.


RESULTS
The admission rate in the south Asians was estimated to be 2.04 times that in the white patients. Most aspects of treatment were similar in the two groups, except that a higher proportion of the south Asians received thrombolytic drugs (81.2% v 73.8%). After adjustment for age, sex, previous myocardial infarction, and treatment with thrombolysis or aspirin, or both, the south Asians had a poorer survival over the six months from myocardial infarction (hazard ratio 2.02 (95% confidence interval 1.14 to 3.56), P = 0.018), but a substantially higher proportion were diabetic (38% v 11%, P < 0.001), and additional adjustment for diabetes removed much of their excess risk (adjusted hazard ratio 1.26 (0.68 to 2.33), P = 0.47).


CONCLUSIONS
South Asian patients had a higher risk of admission with myocardial infarction and a higher risk of death over the ensuing six months than the white patients. The higher case fatality among the south Asians, largely attributable to diabetes, may contribute to the increased risk of death from coronary heart disease in south Asians living in Britain.
Wilkinson
P
P
Environmental Epidemiology Unit, London School of Hygiene and Tropical Medicine.
Sayer
J
J
Laji
K
K
Grundy
C
C
Marchant
B
B
Kopelman
P
P
Timmis
A D
AD
D000328:Adult; D000367:Age Factors; D001459:Bangladesh / Q000208:ethnology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007194:India / Q000208:ethnology; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D010154:Pakistan / Q000208:ethnology; D012737:Sex Factors; D012907:Smoking / Q000208:ethnology / Q000401:mortality; D015996:Survival Rate; D014504:Urban Health