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Country of birth and mortality risk in hypertension with and without diabetes : the Swedish primary care cardiovascular database

Andersson, Tobias ; Pikkemaat, Miriam LU orcid ; Schiöler, Linus ; Hjerpe, Per LU ; Carlsson, Axel C. ; Wändell, Per LU ; Manhem, Karin ; Kahan, Thomas and Bengtsson Boström, Kristina LU (2021) In Journal of Hypertension 39(6). p.1155-1162
Abstract

OBJECTIVES: Hypertension and diabetes are common and are both associated with high cardiovascular morbidity and mortality. We aimed to investigate associations between mortality risk and country of birth among hypertensive individuals in primary care with and without concomitant diabetes, which has not been studied previously. In addition, we aimed to study the corresponding risks of myocardial infarction and ischemic stroke. METHODS: This observational cohort study of 62 557 individuals with hypertension diagnosed 2001-2008 in the Swedish Primary Care Cardiovascular Database assessed mortality by the Swedish Cause of Death Register, and myocardial infarction and ischemic stroke by the National Patient Register. Cox regression models... (More)

OBJECTIVES: Hypertension and diabetes are common and are both associated with high cardiovascular morbidity and mortality. We aimed to investigate associations between mortality risk and country of birth among hypertensive individuals in primary care with and without concomitant diabetes, which has not been studied previously. In addition, we aimed to study the corresponding risks of myocardial infarction and ischemic stroke. METHODS: This observational cohort study of 62 557 individuals with hypertension diagnosed 2001-2008 in the Swedish Primary Care Cardiovascular Database assessed mortality by the Swedish Cause of Death Register, and myocardial infarction and ischemic stroke by the National Patient Register. Cox regression models were used to estimate study outcome hazard ratios by country of birth and time updated diabetes status, with adjustments for multiple confounders. RESULTS: During follow-up time without diabetes using Swedish-born as reference, adjusted mortality hazard ratios per country of birth category were Finland: 1.26 (95% confidence interval 1.15-1.38), high-income European countries: 0.84 (0.74-0.95), low-income European countries: 0.84 (0.71-1.00) and non-European countries: 0.65 (0.56-0.76). The corresponding adjusted mortality hazard ratios during follow-up time with diabetes were high-income European countries: 0.78 (0.63-0.98), low-income European countries: 0.74 (0.57-0.96) and non-European countries: 0.56 (0.44-0.71). During follow-up without diabetes, the corresponding adjusted hazard ratio of myocardial infarction was increased for Finland: 1.16 (1.01-1.34), whereas the results for ischemic stroke were inconclusive. CONCLUSION: In Sweden, hypertensive immigrants (with the exception for Finnish-born) with and without diabetes have a mortality advantage, as compared to Swedish-born.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Hypertension
volume
39
issue
6
pages
8 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85106537798
  • pmid:33298686
ISSN
1473-5598
DOI
10.1097/HJH.0000000000002744
language
English
LU publication?
yes
id
283cab2e-a56d-4107-aa81-35283c126976
date added to LUP
2021-06-11 10:39:54
date last changed
2024-06-01 11:42:19
@article{283cab2e-a56d-4107-aa81-35283c126976,
  abstract     = {{<p>OBJECTIVES: Hypertension and diabetes are common and are both associated with high cardiovascular morbidity and mortality. We aimed to investigate associations between mortality risk and country of birth among hypertensive individuals in primary care with and without concomitant diabetes, which has not been studied previously. In addition, we aimed to study the corresponding risks of myocardial infarction and ischemic stroke. METHODS: This observational cohort study of 62 557 individuals with hypertension diagnosed 2001-2008 in the Swedish Primary Care Cardiovascular Database assessed mortality by the Swedish Cause of Death Register, and myocardial infarction and ischemic stroke by the National Patient Register. Cox regression models were used to estimate study outcome hazard ratios by country of birth and time updated diabetes status, with adjustments for multiple confounders. RESULTS: During follow-up time without diabetes using Swedish-born as reference, adjusted mortality hazard ratios per country of birth category were Finland: 1.26 (95% confidence interval 1.15-1.38), high-income European countries: 0.84 (0.74-0.95), low-income European countries: 0.84 (0.71-1.00) and non-European countries: 0.65 (0.56-0.76). The corresponding adjusted mortality hazard ratios during follow-up time with diabetes were high-income European countries: 0.78 (0.63-0.98), low-income European countries: 0.74 (0.57-0.96) and non-European countries: 0.56 (0.44-0.71). During follow-up without diabetes, the corresponding adjusted hazard ratio of myocardial infarction was increased for Finland: 1.16 (1.01-1.34), whereas the results for ischemic stroke were inconclusive. CONCLUSION: In Sweden, hypertensive immigrants (with the exception for Finnish-born) with and without diabetes have a mortality advantage, as compared to Swedish-born.</p>}},
  author       = {{Andersson, Tobias and Pikkemaat, Miriam and Schiöler, Linus and Hjerpe, Per and Carlsson, Axel C. and Wändell, Per and Manhem, Karin and Kahan, Thomas and Bengtsson Boström, Kristina}},
  issn         = {{1473-5598}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  pages        = {{1155--1162}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Journal of Hypertension}},
  title        = {{Country of birth and mortality risk in hypertension with and without diabetes : the Swedish primary care cardiovascular database}},
  url          = {{http://dx.doi.org/10.1097/HJH.0000000000002744}},
  doi          = {{10.1097/HJH.0000000000002744}},
  volume       = {{39}},
  year         = {{2021}},
}