Ethnic inequalities in acute myocardial infarction and stroke rates in Norway 1994-2009: a nationwide cohort study (CVDNOR).
BACKGROUND
Immigrants to Norway from South Asia and Former Yugoslavia have high levels of cardiovascular disease (CVD) risk factors. Yet, the incidence of CVD among immigrants in Norway has never been studied. Our aim was to study the burden of acute myocardial infarction (AMI) and stroke among ethnic groups in Norway.


METHODS
We studied the whole Norwegian population (n = 2,637,057) aged 35-64 years during 1994-2009. The Cardiovascular Disease in Norway (CVDNOR) project provided information about all AMI and stroke hospital stays for this period, as well as deaths outside hospital through linkage to the Cause of Death Registry. The direct standardization method was used to estimate age standardized AMI and stroke event rates for immigrants and ethnic Norwegians. Rate ratios (RR) with ethnic Norwegians as reference were calculated using Poisson regression.


RESULTS
The highest risk of AMI was seen in South Asians (men RR = 2.27; 95 % CI 2.08-2.49; women RR = 2.10; 95 % CI 1.76-2.51) while the lowest was seen in East Asians (RR = 0.38 in both men (95 % CI 0.25-0.58) and women (95 % CI 0.18-0.79)). Immigrants from Former Yugoslavia and Central Asia also had increased risk of AMI compared to ethnic Norwegians. South Asians had increased risk of stroke (men RR = 1.26; 95 % CI 1.10-1.44; women RR = 1.58; 95 % CI 1.32-1.90), as did men from Former Yugoslavia, Sub-Saharan Africa and women from Southeast Asia.


CONCLUSIONS
Preventive measures should be aimed at reducing the excess numbers of CVD among immigrants from South Asia and Former Yugoslavia.
Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway. kjersti.stormark.rabanal@fhi.no.
Kjersti S
KS
Rabanal
Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway. randi.selmer@fhi.no.
Randi M
RM
Selmer
Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, N-5018, Bergen, Norway. Jannicke.Igland@uib.no.
Jannicke
J
Igland
Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, N-5018, Bergen, Norway. Grethe.Tell@uib.no.|Department of Health Registries, Norwegian Institute of Public Health, Kalfarveien 31, 5018, Bergen, Norway. Grethe.Tell@uib.no.
Grethe S
GS
Tell
Division of Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway. haakon.meyer@fhi.no.|Department of Community Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway. haakon.meyer@fhi.no.
Haakon E
HE
Meyer
D000208:Acute Disease; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D044466:Asian People; D015331:Cohort Studies; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology*; D009664:Norway / Q000453:epidemiology; D012042:Registries; D012306:Risk; D012737:Sex Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000208:ethnology*; D015022:Yugoslavia / Q000208:ethnology