title: Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: roles of age, gender, geography and area-level disadvantage.
abstract: We investigated disparities in rates of acute myocardial infarction (AMI) between Aboriginal and non-Aboriginal people in the 199 Statistical Local Areas (SLAs) in New South Wales, Australia. Using routinely collected and linked hospital and mortality data from 2002 to 2007, we developed multilevel Poisson regression models to estimate the relative rates of first AMI events in the study period accounting for area of residence. Rates of AMI in Aboriginal people were more than two times that in non-Aboriginal people, with the disparity greatest in more disadvantaged and remote areas. AMI rates in Aboriginal people varied significantly by SLA, as did the Aboriginal to non-Aboriginal rate ratio. We identified almost 30 priority areas for universal and targeted preventive interventions that had both high rates of AMI for Aboriginal people and large disparities in rates.
authors.affiliation: Centre for Health Research, School of Medicine, Blg 3 Campbelltown Campus, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia. Electronic address: d.randall@uws.edu.au.
authors.forename: D A
authors.initials: DA
authors.lastname: Randall
authors.affiliation: Centre for Health Research, School of Medicine, Blg 3 Campbelltown Campus, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia; The Sax Institute, PO Box K617, Haymarket, NSW 1240, Australia.
authors.forename: L R
authors.initials: LR
authors.lastname: Jorm
authors.affiliation: Centre for Health Research, School of Medicine, Blg 3 Campbelltown Campus, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Lujic
authors.affiliation: Sydney School of Public Health, Sydney Medical School, Edward Ford Building (A27), The University of Sydney, Sydney, NSW 2006, Australia; Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, VIC 8008, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Eades
authors.affiliation: The Sax Institute, PO Box K617, Haymarket, NSW 1240, Australia.
authors.forename: T R
authors.initials: TR
authors.lastname: Churches
authors.affiliation: School of Medicine, Blg 30 Campbelltown Campus, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: O'Loughlin
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Leyland
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005843:Geography; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000208:ethnology; D009517:New South Wales / Q000453:epidemiology; D016012:Poisson Distribution; D012042:Registries; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Aboriginal health; Acute myocardial infarction; Data linkage; Multilevel modeling