title: Sex disparities in acute myocardial infarction incidence: do ethnic minority groups differ from the majority population?
abstract: BACKGROUND
  The incidence of acute myocardial infarction (AMI) in men exceeds that in women. The extent of this sex disparity varies widely between countries. Variations may also exist between ethnic minority groups and the majority population, but scientific evidence is lacking.
  
  
  METHODS
  A nationwide register-based cohort study was conducted (n = 7,601,785) between 1997 and 2007. Cox Proportional Hazard Models were used to estimate sex disparities in AMI incidence within the Dutch majority population and within ethnic minority groups, stratified by age (30-54, 55-64, ≥65 years).
  
  
  RESULTS
  AMI incidence was higher in men than in women in all groups under study. Compared with the majority population (hazard ratio (HR): 2.23; 95% confidence interval (95% CI): 2.21-2.25), sex disparities were similar among minorities originating from the immediate surrounding countries (Belgium, Germany), whereas they were greater in most other minority groups. Most pronounced results were found among minorities from Morocco (HR: 3.48; 95% CI: 2.48-4.88), South Asia (HR: 3.92; 95% CI: 2.45-6.26) and Turkey (HR: 3.98; 95% CI: 3.51-4.51). Sex disparity differences were predominantly evident in those below 55 years of age, and were mainly provoked by a higher AMI incidence in ethnic minority men compared with men belonging to the Dutch majority population.
  
  
  CONCLUSIONS
  Sex disparities in AMI incidence clearly varied between ethnic minorities and the Dutch majority population. Health prevention strategies may first target at a reduction of AMI incidence in young ethnic minority men, especially those originating from Turkey and South Asia. Furthermore, an increase in AMI incidence in their female counterparts should be prevented.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands l.vanoeffelen@umcutrecht.nl.
authors.forename: Aloysia A M
authors.initials: AA
authors.lastname: van Oeffelen
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
authors.forename: Ilonca
authors.initials: I
authors.lastname: Vaartjes
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D054525:Minority Health / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000208:ethnology*; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012737:Sex Factors
keywords: Coronary heart disease; ethnicity; gender; incidence; migrant; myocardial infarction; sex