title: Time Trends and Educational Inequalities in Out-of-Hospital Coronary Deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) Project.
abstract: Recent time trends and educational gradients characterizing out-of-hospital coronary deaths (OHCD) are poorly described.
  
  
  
  We identified all deaths from coronary heart disease occurring outside the hospital in Norway during 1995 to 2009. Time trends were explored using Poisson regression analysis with year as the independent, continuous variable. Information on the highest achieved education was obtained from The National Education Database and classified as primary (up to 10 years of compulsory education), secondary (high school or vocational school), or tertiary (college/university). Educational gradients in OHCD were explored using Poisson regression, stratified by sex and age (<70 and ≥70 years), and results were expressed as incidence rate ratios (IRRs) and 95%CIs. Of 100 783 coronary heart disease deaths, 58.8% were OHCDs. From 1995 to 2009, age-adjusted OHCD rates declined across all education categories (primary, secondary, and tertiary) in younger men (IRR=0.35; 95%CI 0.32-0.38; IRR=0.38; 95%CI 0.35-0.42; IRR=0.33; 95%CI 0.28-0.40), younger women (IRR=0.47; 95% CI 0.40-0.56; IRR=0.55; 95%CI 0.45-0.67; IRR=0.28; 95% CI 0.16-0.47), older men (IRR=0.20; 95%CI 0.19-0.22; IRR=0.20; 95%CI 0.18-0.22; IRR=0.20; 95%CI 0.17-0.23), and older women (IRR=0.26; 95%CI 0.24-0.28; IRR=0.25; 95%CI 0.23-0.28; IRR=0.28; 95%CI 0.22-0.34). Tertiary education was associated with lower risk of OHCD compared to primary education (IRR=0.37; 95%CI 0.35-0.40 in younger men, IRR=0.26; 95%CI 0.22-0.30 in younger women, IRR=0.52; 95%CI 0.49-0.55 in older men, and IRR=0.61; 95%CI 0.57-0.66 in older women). These gradients did not change over time (Pinteraction=0.25).
  
  
  
  Although OHCD rates declined substantially during 1995 to 2009, they displayed educational gradients that remained constant over time.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway enxhela.sulo@uib.no.
authors.forename: Enxhela
authors.initials: E
authors.lastname: Sulo
authors.affiliation: Department of Clinical Science, University of Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ottar
authors.initials: O
authors.lastname: Nygård
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.|Centre for Burden of Disease, Norwegian Institute of Public Health, Bergen, 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.|Domain for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Marta
authors.initials: M
authors.lastname: Ebbing
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.|Duke Global Health Institute, Duke University, Durham, NC.
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.affiliation: Research Centre for Prevention and Health, Capital Region, Denmark.|Department of Public Health, Institute of Clinical Science, University of Copenhagen, Denmark.|Faculty of Medicine, University of Aalborg, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Sulo
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.|Domain for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D004522:Educational Status; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Norway; coronary artery disease; educational inequalities; epidemiology; mortality; out‐of‐hospital coronary; trends