| Titre : | Time trends of myocardial infarction 28-day case-fatality in the 1990s : is there a contribution from different changes among socioeconomic classes ? (2008) |
| Auteurs : | C. FORNARI ; R. BORCHINI ; G.C. CESANA ; CHAMBLESS (L.E.) : USA. Collaborative Studies Coordinating Centre. Department of Biostatistics. University of North Carolina at Chapel Hill. Chapel Hill. NC. ; CORRAO (G.) : ITA. Dipartimento di Statistica. Università degli Studi di Milano-Bicocca. Milano. ; M.M. FERRARIO ; F. MADOTTO ; Centro di Studio e Ricerca sulla Patologia Cronico-Degenerativa negli Ambienti di Lavoro. Dipartimento di Medicina Clinica. Prevenzione e Biotecnologie Sanitarie. Università degli Studi di Milano-Bicocca. Monza. ITA ; Medicina del Lavoro e Preventiva. Dipartimento di Scienze Cliniche e Biologiche. Università degli Studi dell'lnsubria e Ospedale di Circolo-Fondazione Macchi. Varese. ITA ; Monica Brianza-Camuni Research Group. ITA |
| Type de document : | Article |
| Dans : | Journal of epidemiology and community health (vol. 62, n° 7, 2008) |
| Pagination : | 593-598 |
| Langues: | Anglais |
| Mots-clés : | Tendance séculaire ; Mortalité ; Mort ; Changement ; Facteur socioéconomique ; Cardiopathie coronaire |
| Résumé : | [BDSP. Notice produite par INIST-CNRS Fs7R0xq9. Diffusion soumise à autorisation]. Background/objective : Almost two-thirds of the coronary death rate decrease in the northern Italian Brianza MONICA male population, between 1993-4 and 1997-8, are attributable to a reduction in 28-day myocardial infarction (Ml) case-fatality. The present paper investigates the factors associated with Ml case-fatality decrease and in particular the role of socio-occupational classes (SOCs). Methods : Standardised information on acute coronary care and intervention before and during the hospitalisation was collected for all coronary events (n=1817) registered in 1993-4 and in 1997-8 among 35-64-year-old male residents in Brianza. Deaths within 28 days after Ml were carefully investigated. Five SOCs were defined adopting the Erikson-Goldthorpe-Portocarero method. Differences in 28-day Ml case-fatality and in acute phase intervention and treatment over time and among SOCs in each period were assessed. Results : 28-day Ml case-fatality reduction (27.2%) can be mainly attributed to a decreased proportion of Ml events that were fatal before reaching the hospital. In the lower SOCs significant changes in Ml case-fatality were detected between 1993-4 and 1997-8. Differences in acute phase intervention and treatment between the periods were observed. SOC differences both in prevalence of out-of-hospital cardiac arrest and in the pre-hospital qualified intervention score were detected in the first period only. Conclusions : In the study population Ml case-fatality reduction can be mainly attributed to a more effective and prompt management before hospitalisation and to an improvement in acute treatment during hospitalisation. This enhancement is made available to the whole population overtaking social differences. |
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