title: Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study.
abstract: OBJECTIVE
  We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin and medical treatment were mediated by socioeconomic status (SES).
  
  
  METHODS
  This register-based follow-up study consisted of individuals >17 years of age, admitted to hospital with AMI between 2001 and 2005 (n=25,443). Danish-born residents were compared with immigrants from Turkey, Pakistan and Yugoslavia. Individuals were identified by civil registration number, and data were obtained through linkage to the national registers of hospitalisations and drug prescriptions. Odds of initiating treatment and hazard ratios (HR) of terminating treatment were estimated. Mediators such as income and employment were included in the models.
  
  
  RESULTS
  Pakistanis were less likely than Danish-born residents to initiate treatment with beta-blockers after AMI [odds ratio 0.52; 95% confidence interval (CI) 0.34-0.80]. Immigrants from Turkey (HR 1.36; 95% CI 1.07-1.73) and Pakistan (HR 1.59; 95% CI 1.21-2.08) were more likely to terminate treatment with beta-blockers before being recommended to do so. Estimates did not change markedly when income and education were included in the models.
  
  
  CONCLUSIONS
  The results of this study suggest that immigrants from Pakistan and Turkey do not receive adequate medical treatment with beta-blockers after a first AMI compared with Danish-born residents. Mediators such as income and employment may not be sufficient indicators of SES when the effect of patient origin on medical treatment is explored. A lower SES of immigrants, communication problems between doctor and patient and doctors' attitudes towards immigrants may explain ethnic differences in medical treatment after AMI.
authors.affiliation: Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Building 84/85, DK-2600 Glostrup, Denmark. nabf@glo.regionh.dk
authors.forename: Nana Folmann
authors.initials: NF
authors.lastname: Hempler
authors.forename: Finn
authors.initials: F
authors.lastname: Diderichsen
authors.forename: Finn Breinholt
authors.initials: FB
authors.lastname: Larsen
authors.forename: Steen
authors.initials: S
authors.lastname: Ladelund
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D003718:Denmark; D054242:Emigrants and Immigrants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000208:ethnology*; D010154:Pakistan / Q000208:ethnology; D012923:Social Class; D014421:Turkey / Q000208:ethnology; D015022:Yugoslavia / Q000208:ethnology
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
references.citation: BMC Health Serv Res. 2006 Sep 13;6:115
references.pmid: 16970807
references.citation: Am J Med. 2006 Jan;119(1):70.e9-15
references.pmid: 16431192
references.citation: J Clin Epidemiol. 2003 Feb;56(2):124-30
references.pmid: 12654406
references.citation: Patient Educ Couns. 2006 Dec;64(1-3):21-34
references.pmid: 16427760
references.citation: Ethn Dis. 2001 Autumn;11(3):401-11
references.pmid: 11572406
references.citation: J Public Health Med. 2002 Jun;24(2):95-105
references.pmid: 12141592
references.citation: Br J Clin Pharmacol. 2005 Nov;60(5):534-42
references.pmid: 16236044
references.citation: Soc Sci Med. 2002 Mar;54(5):693-706
references.pmid: 11999487
references.citation: J Gen Intern Med. 2007 Jun;22(6):768-74
references.pmid: 17364243
references.citation: JAMA. 1998 Jul 22-29;280(4):356-62
references.pmid: 9686553
references.citation: J Natl Med Assoc. 2003 Jan;95(1):17-27
references.pmid: 12656446
references.citation: BMJ. 1991 Mar 9;302(6776):560-4
references.pmid: 2021718
references.citation: Soc Sci Med. 2006 Nov;63(9):2407-17
references.pmid: 16928417
references.citation: Heart. 2008 Apr;94(4):463-70
references.pmid: 17690159
references.citation: J Public Health (Oxf). 2007 Jun;29(2):191-8
references.pmid: 17456532
references.citation: BMJ. 1999 Jun 26;318(7200):1730-7
references.pmid: 10381708
references.citation: Eur J Clin Pharmacol. 2008 Apr;64(4):417-24
references.pmid: 18180914
references.citation: Eur J Epidemiol. 2005;20(9):755-60
references.pmid: 16170658
references.citation: Lancet. 2003 Jun 14;361(9374):2005-16
references.pmid: 12814710
references.citation: J Epidemiol Community Health. 2007 Dec;61(12):1091-7
references.pmid: 18000133
references.citation: Pharmacoepidemiol Drug Saf. 2006 Aug;15(8):565-74; discussion 575-7
references.pmid: 16514590