Ethnical disparities in temporal trends of acute myocardial infarction (AMI) throughout a decade in Israel. Soroka acute myocardial infarction (SAMI-II) project.
BACKGROUND
Ethnical disparities in presentation and outcomes following AMI were reported. We evaluated the temporal-trends of AMI hospitalizations and mortality of Bedouins (Muslims) and Jews in Israel.


METHODS
Retrospective analysis of 15,352 AMI admissions (10,652 patients; 11.3% Bedouins, 88.7% Jews) throughout 2002-2012. The trends in admission rates (AR) were compared using direct age-sex adjustment. The trends of in-hospital mortality (IHM) and 1-year post-discharge mortality (PDM) were adjusted for the patients' characteristics.


RESULTS
Bedouins were younger (61.7±14.3 vs. 68.8±13.7years, p<0.001), a higher rate of males. Different prevalence of cardiovascular risk factors was found. STEMI presentation, 3-vessel disease and PCI intervention were more frequently in Bedouins than Jews. Adjusted AR was lower among Jews (4.80/1000 and 3.24/1000 in 2002 and 2012 respectively) than in Bedouins (9.63/1000 and 5.13/1000). A significant decrease of adjusted AR was found in both ethnicities (p-for-trend<0.001 both), greater in Bedouins (p-for-disparity=0.017). The overall rate of IHM was higher for Jews (8.7% vs. 5.6%; p=0.001). The decline of IHM was found in both groups: an increase of one-year resulted in AdjOR=0.877; (p-for-trend<0.001) and 0.910 (p-for-trend=0.052) in Jews and Bedouins respectively (p-for-interaction=0.793). The rates of PDM were higher for Jews (13.6% vs. 9.9%; p=0.001). The risk for PDM increased in both groups: AdjOR=1.118; (p-for-trend<0.001) and 1.093; (p-for-trend=0.012) for one-year increase, for Jews and Bedouins respectively (p-for-interaction=0.927).


CONCLUSIONS
Throughout 2002-2012 Bedouin AMI patients differed from Jews. Adjusted incidence of AMI declined, greater in Bedouins. IHM declined and PDM increased in both groups. A culturally sensitive prevention program is warranted.
Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: Plakht@exchange.bgu.ac.il.
Ygal
Y
Plakht
Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Harel
H
Gilutz
Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Arthur
A
Shiyovich
D000368:Aged; D000369:Aged, 80 and over; D018912:Arabs / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality / Q000208:ethnology* / Q000639:trends; D006801:Humans; D007557:Israel / Q000453:epidemiology / Q000208:ethnology; D007585:Jews / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality*; D012189:Retrospective Studies
Acute myocardial infarction; Ethnical disparities; Hospital survival; Mid-term survival; Prognosis; Temporal trends