title: Related factors and incidence risk of acute myocardial infarction among the people with disability: A national population-based study.
abstract: Cardiovascular disease has always been a leading cause of death worldwide. Because the mobility of people with disability is relatively decreased, their risk of cardiovascular disease is increased. This study investigated the risks and relevant factors of acute myocardial infarction (AMI) among people with disability. This is a retrospective cohort study based on secondary data analysis. This study focused on 798,328 people with disability who were aged 35 and above during 2002-2008 and were registered in the National Disability Registration Database; the relevant medical data from 2000 to 2011 were acquired from the National Health Insurance Research Database. A Cox proportional hazards model was adopted for analyzing the relative AMI risks among different disability types and finding latent risk factors. The results indicated that the AMI incidence rate (per 1000 patient-years) among people with disability was 2.48. Men had an AMI incidence rate of 2.68 per 1000 patient-years, which was significantly higher than that of women (2.21; p<.05). The AMI risk for people with mental disabilities was 0.76 times the risk for people with physical disabilities (95% confidence interval [CI]=0.71-0.82). The AMI risk for people with profound disabilities was 2.04 times (95% CI=1.93-2.16) the risk for people with mild disabilities. AMI risk increased with age. People with disability aged 65 and above had an AMI risk that was 5.01-6.03 times the risk for people with disability aged below 45. Disabled indigenous people had a relatively higher AMI risk (HR=1.35, 95% CI=1.19-1.52). The AMI risk for people with disability with a Charlson comorbidity index (CCI) of 4 and above was 5.89 times (95% CI=5.56-6.25) the risk for those with a CCI of 0. Compared with people with physical disabilities, people with visual impairment and people with dysfunctional primary organs had significantly higher AMI risks (HR=1.15; HR=1.66). This study found that people with disability who were male, aged 65 and above, married, indigenous, with physical disabilities, with high comorbidity, or with high disability levels had relatively higher AMI risks than other people with disability. The research outcomes can be used as references by public health authorities to improve the engagement of people with disability in AMI-prevention health services.
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; China Medical University Hospital, Taichung, Taiwan, ROC.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Huang
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC.
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.affiliation: China Medical University Hospital, Taichung, Taiwan, ROC.
authors.forename: Li-Ting
authors.initials: LT
authors.lastname: Chiu
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC. Electronic address: wtsai@mail.cmu.edu.tw.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
keywords: Acute myocardial infarction; Disabilities; Mental disability; Physical disability; Risk factor