title: In northern Sweden myocardial infarction morbidity and case fatality are lowest in rural areas.
abstract: OBJECTIVE
  Previous studies have shown differences in the main cardiovascular risk factors between communities of different sizes in northern Sweden, with serum cholesterol levels, systolic blood pressure and body mass index being higher, but with fewer smokers in the smallest communities. We wanted to see if there also were differences in the morbidity and 28-day case fatality in acute myocardial infarction (AMI) between communities of different sizes in this area.
  
  
  METHODS
  The Northern Sweden MONICA Project database of AMI was examined for the years 1985-1999 for age-adjusted morbidity and 28-day case fatality for each sex in relation to the size of the community where each case lived.
  
  
  RESULTS
  The age standardized morbidity and 28-day case fatality were the lowest in the smallest communities where the risk factor burden previously was shown to be highest, and the highest in intermediate size communities.
  
  
  CONCLUSIONS
  Other factors than conventional biomedical risk factors seem to either confer protection in the smallest communities or increase the AMI risk in larger communities.
authors.affiliation: Department of Internal Medicine, Kiruna District Hospital, Sweden. torbjorn.messner@nll.se
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Messner
authors.forename: Vivan
authors.initials: V
authors.lastname: Lundberg
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality*; D015397:Program Evaluation; D012111:Residence Characteristics / Q000145:classification*; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors