title: Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study.
abstract: BACKGROUND
  Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes.
  
  
  METHODS
  Admission records were linked to mortality records for 60047 patients aged 25-84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality.
  
  
  RESULTS
  Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status.
  
  
  CONCLUSIONS
  Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people.
authors.affiliation: School of Medicine, University of Western Sydney, Narellan Road, Campbelltown, NSW, Australia. d.randall@uws.edu.au
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Randall
authors.forename: Louisa R
authors.initials: LR
authors.lastname: Jorm
authors.forename: Sanja
authors.initials: S
authors.lastname: Lujic
authors.forename: Aiden J
authors.initials: AJ
authors.lastname: O'Loughlin
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Churches
authors.forename: Mary M
authors.initials: MM
authors.lastname: Haines
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Eades
authors.forename: Alastair H
authors.initials: AH
authors.lastname: Leyland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000401:mortality*; D009517:New South Wales / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data* / Q000639:trends; D015995:Prevalence; D012737:Sex Factors; D013997:Time Factors