title: Aboriginal to non-Aboriginal differentials in 2-year outcomes following non-fatal first-ever acute MI persist after adjustment for comorbidity.
abstract: BACKGROUND
  We investigated the relationship between Aboriginality and 2-year cardiovascular disease outcomes in non-fatal first-ever myocardial infarction during 2000-04, with progressive adjustment of covariates, including comorbidities.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Person-linked hospital and mortality records were used to identify 28-day survivors of first-ever myocardial infarction in Western Australia during 2000-04 with 15-year lookback. The outcome measures were: (1) cardiovascular disease death; (2) recurrent admission for myocardial infarction; and (3) the composite of (1) and (2).
  
  
  RESULTS
  Compared with non-Aboriginal patients, Aboriginals were younger and more likely to live remotely. The proportions having 5-year histories of diabetes and chronic kidney disease were double and triple those of non-Aboriginals. When adjusting for demographic variables alone, the Aboriginal to non-Aboriginal hazard ratios for cardiovascular death or recurrent myocardial infarction were 3.6 (95% CI 2.5-5.3) in men and 4.5 (95% CI 2.8-7.3) in women. After adjustment for comorbidities, including diabetes, chronic kidney disease and heart failure, the hazard ratios decreased 36% and 47% to 2.3 (1.6-3.0) and 2.4 (1.5-4.0) in males and females, respectively.
  
  
  CONCLUSIONS
  The high prevalence of comorbidities in Aboriginal people, including diabetes, kidney disease, heart failure, and other risk factors contribute substantially to the disparity in post-myocardial infarction outcomes in Aboriginal people, reinforcing the importance of both primary prevention and comprehensive management of chronic conditions in this population. Aboriginality remains a significant independent risk factor for disease recurrence or mortality, even after adjusting for comorbidity, suggesting the need for society-level interventions addressing social disadvantage.
authors.affiliation: School of Population Health, University of Western Australia, Perth, Australia. judith.katzenellenbogen@uwa.edu.au
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.forename: Michael S T
authors.initials: MS
authors.lastname: Hobbs
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
authors.forename: Steve C
authors.initials: SC
authors.lastname: Ridout
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Knuiman
authors.forename: Lyn
authors.initials: L
authors.lastname: Dimer
authors.forename: Kate P
authors.initials: KP
authors.lastname: Taylor
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thompson
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000208:ethnology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology