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


RESULTS
Between 1986 and 1995, 83365 people died from acute myocardial infarction, out of hospital and without previous hospital admission (44655 men, 38710 women); and 117749 were admitted with a first acute myocardial infarction, of whom 37020 died within 1 year. Thus, out-of-hospital deaths accounted for 69.2% (95% CI 69.0-69.5) of all 120385 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.


CONCLUSIONS
These inequalities in age, sex, and socioeconomic class should be actively addressed by prevention strategies for coronary heart disease.
Capewell
S
S
Department of public Health, University of Glasgow, Glasgow, UK. capewell@liverpool.ac.uk
MacIntyre
K
K
Stewart
S
S
Chalmers
J W
JW
Boyd
J
J
Finlayson
A
A
Redpath
A
A
Pell
J P
JP
McMurray
J J
JJ
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011159:Population Surveillance; D012189:Retrospective Studies; D012606:Scotland; D017678:Sex Distribution; D012923:Social Class