title: Disparities in the incidence of acute myocardial infarction: long-term trends from the Hunter region.
abstract: BACKGROUND
  Trends in the incidence of acute myocardial infarction (AMI) provide important information for healthcare providers and can allow for accurate planning of future health needs and targeted interventions in areas with an excess burden of cardiovascular disease.
  
  
  OBJECTIVE
  To investigate the regional variations in AMI incidence in the Hunter region.
  
  
  METHODS
  Incident cases of AMI identified between 1996 and 2013 from the Hunter New England Health Cardiac and Stroke Outcomes Unit were prospectively collected for this study. We calculated crude and age-adjusted incidence of AMI over an 18-year period and explored differences in remoteness, age, sex and indigenous status.
  
  
  RESULTS
  During 1996-2013, a total of 15 480 cases of AMI were identified. There was a significantly higher incidence of AMI in patients from regional areas compared to patients from metropolitan areas. More importantly, while rates of AMI declined by 28% in metropolitan patients, they increased by 8% in regional patients. Males had higher rates of AMI throughout the study period than females, however there was trend over time towards a reduction in AMI incidence in males that was not seen in females. The age-adjusted incidence of AMI for indigenous patients increased by 48% from 2007 to 2013, compared to a 23% decrease in non-indigenous patients.
  
  
  CONCLUSIONS
  Between 1996 and 2013 in the Hunter region, the adjusted incidence of AMI increased for regional patients compared to metropolitan patients with a trend towards a higher adjusted incidence of AMI in the indigenous population.
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Allan J
authors.identifier: http://orcid.org/0000-0002-5929-3472
authors.initials: AJ
authors.lastname: Davies
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Crystal
authors.initials: C
authors.lastname: Naudin
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.|School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Omary
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Arshad
authors.initials: A
authors.lastname: Khan
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Oldmeadow
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Jones
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bastian
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Bhagwandeen
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Fletcher
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Leitch
authors.affiliation: Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia.|School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Boyle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000639:trends*; D013997:Time Factors; D014505:Urban Population / Q000639:trends*
keywords: acute myocardial infarction; epidemiology; health disparity; incidence; indigenous health