scholarly journals Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliane Tetzlaff ◽  
Siegfried Geyer ◽  
Mechthild Westhoff-Bleck ◽  
Stefanie Sperlich ◽  
Jelena Epping ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Social Inequalities ◽  
Mortality Risks ◽  
Socially Disadvantaged ◽  
Life Years ◽  
Incidence And Mortality ◽  
Low Incomes ◽  
Health Insurance Provider ◽  
Length Of Life ◽  
German Statutory Health Insurance

Abstract Background Acute myocardial infarction (MI) remains a frequent health event and a major contributor to long-term impairments globally. So far, research on social inequalities in MI incidence and mortality with respect to MI severity is limited. Furthermore, evidence is lacking on disparities in the length of life affected by MI. This study investigates social inequalities in MI incidence and mortality as well as in life years free of MI and affected by the consequences of mild or severe MI. Methods The study is based on data of a large German statutory health insurance provider covering the years 2008 to 2017 (N = 1,253,083). Income inequalities in MI incidence and mortality risks and in life years with mild or severe MI and without MI were analysed using multistate analyses. The assessment of MI severity is based on diagnosed heart failure causing physical limitations. Results During the study period a total of 39,832 mild MI, 22,844 severe MI, 276,582 deaths without MI, 15,120 deaths after mild MI and 16,495 deaths after severe MI occurred. Clear inequalities were found in MI incidence and mortality, which were strongest among men and in severe MI incidence. Moreover, substantial inequalities were found in life years free of MI in both genders to the disadvantage of those with low incomes and increased life years after mild MI in men with higher incomes. Life years after severe MI were similar across income groups. Conclusions Social inequalities in MI incidence and mortality risks led to clear disparities in the length of life free of MI with men with low incomes being most disadvantaged. Our findings stress the importance of primary and secondary prevention focusing especially on socially disadvantaged groups.

scholarly journals Widening or narrowing income inequalities in myocardial infarction? Time trends in life years free of myocardial infarction and after incidence

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Juliane Tetzlaff ◽  
Fabian Tetzlaff ◽  
Siegfried Geyer ◽  
Stefanie Sperlich ◽  
Jelena Epping
Keyword(s):  
Myocardial Infarction ◽  
Low Income ◽  
Income Group ◽  
Federal State ◽  
Men And Women ◽  
Mortality Risks ◽  
Income Inequalities ◽  
Life Years ◽  
Incidence And Mortality ◽  
Over Time

Abstract Background Despite substantial improvements in prevention and therapy, myocardial infarction (MI) remains a frequent health event, causing high mortality and serious health impairments. Previous research lacks evidence on how social inequalities in incidence and mortality risks developed over time, and on how these developments affect the lifespan free of MI and after MI in different social subgroups. This study investigates income inequalities in MI-free life years and life years after MI and whether these inequalities widened or narrowed over time. Methods The analyses are based on claims data of a large German health insurance provider insuring approximately 2.8 million individuals in the federal state Lower Saxony. Trends in income inequalities in incidence and mortality were assessed for all subjects aged 60 years and older by comparing the time periods 2006–2008 and 2015–2017 using multistate survival models. Trends in the number of life years free of MI and after MI were calculated separately for income groups by applying multistate life table analyses. Results MI incidence and mortality risks decreased over time, but declines were strongest among men and women in the higher-income group. While life years free of MI increased in men and women with higher incomes, no MI-free life years were gained in the low-income group. Among men, life years after MI increased irrespective of income group. Conclusions Income inequalities in the lifespan spent free of MI and after MI widened over time. In particular, men with low incomes are disadvantaged, as life years spent after MI increased, but no life years free of MI were gained.

scholarly journals Compression, expansion, or maybe both? Growing inequalities in lung cancer in Germany

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242433
Author(s):  
Fabian Tetzlaff ◽  
Jelena Epping ◽  
Heiko Golpon ◽  
Juliane Tetzlaff
Keyword(s):  
Lung Cancer ◽  
Social Inequalities ◽  
Income Group ◽  
Incidence Rates ◽  
Vulnerable Groups ◽  
Survival Models ◽  
Gender Inequalities ◽  
Life Years ◽  
Incidence And Mortality ◽  
Health Insurance Provider

Background Lung Cancer (LC) is one of the most common malign diseases worldwide. So far, it is unclear if the development of LC incidence and mortality leads to morbidity compression or expansion and whether these developments differ by socioeconomic characteristics. This study analyses time trends in social and gender inequalities in life years with and without LC in Germany. Methods The study is based on data of a large German statutory health insurance provider (N = 2,511,790). Incidence and mortality risks were estimated from multistate survival models. Trends in life years with and without LC were analysed using multistate life table analyses. All analyses were performed separately for gender, time period (2006–2009 and 2014–2017), and income group (<60% and ≥60% of the German average income). Results Among men, declining LC incidence rates resulted in gains of life years free of LC and declining LC- affected life years and led to a relative compression, which was strongest in men with higher incomes. Among women, a clear increase in life years with LC led to an expansion of the lifespan affected by LC. This expansion was mainly driven by increasing incidence rates in women with low incomes. Overall, income inequalities in LC increased in both genders. Conclusions Our analyses reveal that developments in the length of life affected by LC differed substantially by gender and income and led to widening health inequalities over time. Public health efforts should mainly focus on vulnerable groups to reduce the persisting social inequalities in LC.

Social inequalities in overweight and obesity in 26 European countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Charafeddine ◽  
S Demarest ◽  
S Drieskens ◽  
F Renard
Keyword(s):  
Weight Status ◽  
Social Inequalities ◽  
Linear Models ◽  
Overweight And Obesity ◽  
Consistent Pattern ◽  
European Countries ◽  
Reverse Inequality ◽  
Socially Disadvantaged ◽  
And Gender ◽  
Low Educated

Abstract Background Previous studies have shown inequalities in overweight and obesity in disfavor of the socially disadvantaged groups. This study examines the extent of these inequalities in 26 European countries. Methods Data from the 2017 EU Statistics on Income and living Conditions (EU-SILC) were used (18 years and older, n = 482,595). A body mass index of 25.0 to 29.9 kg/m2 was classified as overweight and 30.0 and more as obese. Educational level (EL) was used as socioeconomic indicator. Generalized linear models were fitted to compute low-versus high absolute (RD) and relative (RR) inequality. Absolute inequality amplitude (RDA) was calculated as RD/Prevalence. Results Among men, average EU inequalities for overweight were slightly in disfavor of the low educated (RR = 1.05, RDA=5%). A mixed inequality pattern was observed across countries, as the risk of overweight was higher among high educated men in most Eastern countries, in contrast to other parts of Europe (RR from 0.74 to 1.19, RDA from -27% to 20%). Male obesity showed more pronounced inequalities (RR = 1.22, RDA=18%), and a consistent pattern of higher risk among the low educated and wide variation across countries (RR from 1.20 to 2.18, RDA from 16% to 49%). Among women, significant inequalities in overweight were observed (RR = 1.23, RDA=21%), with a consistent pattern of higher risk among the lowest EL, and substantial variation across countries (RR from 1.06 to 1.53, RDA from 7% to 36%). Inequalities were even larger for female obesity, with average RR and RDA reaching 1.49 and 35%, and wider variation (RR from 1.35 to 2.77, RDA from 12% to 88%). Conclusions Social inequalities in weight status are widespread in Europe, but vary substantially between countries. Inequalities are larger among women. For male overweight, a reverse inequality is observed in most Eastern countries. This study allows countries to benchmark the inequalities observed nationally to the situation in other EU countries. Key messages Social inequalities in weight status are widespread in Europe. The pattern of social inequalities in overweight and obesity varies substantially by country and gender.

Incidence and Mortality of Myocardial Infarction and Stroke in Patients with Hyperthyroidism: A Nationwide Cohort Study in Korea

Thyroid ◽  
2020 ◽  
Vol 30 (7) ◽  
pp. 955-965 ◽  
Author(s):  
Hyun Jung Kim ◽  
Taeuk Kang ◽  
Min Ji Kang ◽  
Hyeong Sik Ahn ◽  
Seo Young Sohn
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Incidence And Mortality

scholarly journals The effect of statin treatment on survival and on the use of healthcare resources among patients with acute myocardial infarction

2018 ◽  
pp. 30-48
Author(s):  
Lien Nguyen ◽  
Unto Häkkinen ◽  
Henna Jurvanen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Linear Models ◽  
Statin Treatment ◽  
Data Set ◽  
Hospitalised Patients ◽  
Life Years ◽  
Matched Data ◽  
The Cost ◽  
Statin Use

The aim of this study was to investigate the cost-effectiveness of statin use by newly hospitalised patients with acute myocardial infarction (AMI) in Finland. The data were from the PERFECT database of patients hospitalised for AMI and discharged in 1998–2012 in Finland. Selected patients had first-time AMI and had not used statins earlier (N=60 404). We generated a matched data set from statin non-users for statin users based on propensity matching analysis (N=28 412), which was also used. Statin use was defined as statins purchased within the first week after hospital discharge. Healthcare costs included costs of inpatient and outpatient hospital care, costs of nursing homes and costs of prescribed medicines (at 2011 prices). The follow-up time was one year. Logit and generalised linear models were used. We measured the effects of statin use as life years (LYs) gained and computed costs per LY gained. Both data were analysed for the entire period and for subperiods 1998–2001, 2002–2007 and 2008–2011, without discount rates and with a 3% discount rate. An average patient would gain 0.26–0.51 more years. The estimated costs per LY gained ranged between EUR 800 and 15 000. They were highest (EUR 12 000–15 000) in 1998–2001 by the matched data, but were actually savings in 2008–2011. The estimated costs indicate that statin use in treating AMI was very cost-effective. However, our rather long study period may suggest that the cost estimates per LY gained could be overestimated, as the life expectancy of AMI patients is likely shorter than that of the general population.Published: Online April 2018.

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