title: Coronary angiography and myocardial revascularization following the first acute myocardial infarction in Norway during 2001-2009: Analyzing time trends and educational inequalities using data from the CVDNOR project.
abstract: BACKGROUND
  We analyzed trends in the utilization of coronary angiography and revascularization - including percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) - related to the first AMI and explored potential educational inequalities in such procedures.
  
  
  RESULTS
  All first AMI patients aged 35-89, hospitalized during 2001-2009 were retrieved from 'The Cardiovascular Disease in Norway' project. Information on education was obtained from The Norwegian Education Database. Gender and age group-specific trends in coronary procedures were analyzed using Joinpoint regression. Educational inequalities were explored using multivariable Poisson regression and reported as incidence rate ratios (IRR). A total of 104 836 patients (37.3% women) were included. Revascularization rates increased on average 9.0% and 15.4% per year among younger (35-64years) and older (65-89years) men. Corresponding increases among women were 5.6% and 16.6%. Compared to patients with primary education only, those with secondary and tertiary education had 8% (IRR=1.08, 95% CI; 1.06-1.10) and 12% (IRR=1.12, 95% CI; 1.09-1.14) higher revascularization rates. Educational inequalities were entirely driven by educational differences in receiving coronary angiography (IRR=1.10, 95% CI; 1.08-1.11 for secondary versus primary and IRR=1.14, 95% CI; 1.12-1.16 for tertiary versus primary education level.) Among diagnosed patients, no educational differences were observed in coronary revascularization rates.
  
  
  CONCLUSIONS
  Revascularization rates increased whereas educational differences in revascularization decreased among AMI patients in Norway during 2001-2009. Lower coronary revascularization rates among patients with low education were explained by educational differences in receiving coronary angiography.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway. Electronic address: Enxhela.Sulo@uib.no.
authors.forename: Enxhela
authors.initials: E
authors.lastname: Sulo
authors.affiliation: Section for Cardiology, Department of Clinical Science, University of Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Norway.
authors.forename: Ottar
authors.initials: O
authors.lastname: Nygård
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Norway.
authors.forename: Stein Emil
authors.initials: SE
authors.lastname: Vollset
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.
authors.forename: Jannicke
authors.initials: J
authors.lastname: Igland
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Norway.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Sulo
authors.affiliation: Department of Health Registries, Norwegian Institute of Public Health, Norway.
authors.forename: Marta
authors.initials: M
authors.lastname: Ebbing
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Norway.
authors.forename: Grace M
authors.initials: GM
authors.lastname: Egeland
authors.affiliation: Division of Cardiology, University of British Columbia, Canada.
authors.forename: Nathaniel M
authors.initials: NM
authors.lastname: Hawkins
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Norway.
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000706:statistics & numerical data / Q000639:trends*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data / Q000639:trends*; D009664:Norway / Q000453:epidemiology; D012959:Socioeconomic Factors; D013223:Statistics as Topic / Q000379:methods; D013997:Time Factors
keywords: AMI; CABG; Coronary angiography; Educational inequalities; Epidemiology; PCI