Ma nagement a nd outcome in foreign-born vs native-born patients with myocardial infarction in Sweden
(2024) In European Heart Journal - Quality of Care and Clinical Outcomes 10(6). p.507-522- Abstract
Aims Previous studies on disparities in healthcare and outcomes have shown conflicting results. The aim of this study was to assess differences in baseline characteristics, management, and outcomes in myocardial infarction (MI) patients, by country of birth. Met hods a nd results In total, 194 259 MI patients (64% male, 15% foreign-born) from the nationwide SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry were included and compared by geographic region of birth. The primary outcome was 1-year major adverse cardiovascular events (MACEs) including all-cause death, MI, and stroke. Secondary outcomes were long-term MACE (up to 12... (More)
Aims Previous studies on disparities in healthcare and outcomes have shown conflicting results. The aim of this study was to assess differences in baseline characteristics, management, and outcomes in myocardial infarction (MI) patients, by country of birth. Met hods a nd results In total, 194 259 MI patients (64% male, 15% foreign-born) from the nationwide SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry were included and compared by geographic region of birth. The primary outcome was 1-year major adverse cardiovascular events (MACEs) including all-cause death, MI, and stroke. Secondary outcomes were long-term MACE (up to 12 years), the individual components of MACE, 30-day mortality, management, and risk factors. Logistic regression, Cox proportional hazard models, and propensity score match (PSM), accounting for baseline differences, were used. Foreign-born patients were younger, often male, and had a higher cardiovascular (CV) risk factor burden, including smoking, diabetes, and hypertension. In PSM analyses, Asia-born patients had higher likelihood of revascularization [odds ratio 1.16, 95% confidence interval (CI) 1.04-1.30], statins and beta-blocker prescription at discharge, and a 34% lower risk of 30-day mor tality. Fur thermore, no statistically significant differences were found in primary outcomes except for Asia-born patients having lower risk of 1-year MACE [hazard ratio (HR) 0.85, 95% CI 0.73-0.98], driven by lower mortality (HR 0.72, 95% CI 0.57-0.91). The results persisted over the long-term follow-up. Conclusion This study shows that in a system with universal healthcare coverage in which acute and secondary preventive treatments do not differ by country of birth, foreign-born patients, despite higher CV risk factor burden, will do at least as well as native -born patients.
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- author
- Zwackman, Sammy ; Häggström, Jenny ; Hagström, Emil ; Jernberg, Tomas ; Karlsson, Jan Erik ; Lawesson, Sofia Sederholm LU ; Leosdottir, Margret LU ; Ravn-Fischer, Annica ; Eriksson, Marie and Alfredsson, Joakim
- organization
- publishing date
- 2024-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiovascular risk profile, Country of birth, Disparities, Immigrants, Myocardial infarction, Outcomes
- in
- European Heart Journal - Quality of Care and Clinical Outcomes
- volume
- 10
- issue
- 6
- pages
- 16 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:38453451
- scopus:85204068791
- ISSN
- 2058-5225
- DOI
- 10.1093/ehjqcco/qcae020
- language
- English
- LU publication?
- yes
- id
- 9b4b0521-012a-435f-953f-a7aa6debf888
- date added to LUP
- 2024-11-15 13:00:55
- date last changed
- 2025-07-12 09:18:12
@article{9b4b0521-012a-435f-953f-a7aa6debf888,
abstract = {{<p>Aims Previous studies on disparities in healthcare and outcomes have shown conflicting results. The aim of this study was to assess differences in baseline characteristics, management, and outcomes in myocardial infarction (MI) patients, by country of birth. Met hods a nd results In total, 194 259 MI patients (64% male, 15% foreign-born) from the nationwide SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry were included and compared by geographic region of birth. The primary outcome was 1-year major adverse cardiovascular events (MACEs) including all-cause death, MI, and stroke. Secondary outcomes were long-term MACE (up to 12 years), the individual components of MACE, 30-day mortality, management, and risk factors. Logistic regression, Cox proportional hazard models, and propensity score match (PSM), accounting for baseline differences, were used. Foreign-born patients were younger, often male, and had a higher cardiovascular (CV) risk factor burden, including smoking, diabetes, and hypertension. In PSM analyses, Asia-born patients had higher likelihood of revascularization [odds ratio 1.16, 95% confidence interval (CI) 1.04-1.30], statins and beta-blocker prescription at discharge, and a 34% lower risk of 30-day mor tality. Fur thermore, no statistically significant differences were found in primary outcomes except for Asia-born patients having lower risk of 1-year MACE [hazard ratio (HR) 0.85, 95% CI 0.73-0.98], driven by lower mortality (HR 0.72, 95% CI 0.57-0.91). The results persisted over the long-term follow-up. Conclusion This study shows that in a system with universal healthcare coverage in which acute and secondary preventive treatments do not differ by country of birth, foreign-born patients, despite higher CV risk factor burden, will do at least as well as native -born patients.</p>}},
author = {{Zwackman, Sammy and Häggström, Jenny and Hagström, Emil and Jernberg, Tomas and Karlsson, Jan Erik and Lawesson, Sofia Sederholm and Leosdottir, Margret and Ravn-Fischer, Annica and Eriksson, Marie and Alfredsson, Joakim}},
issn = {{2058-5225}},
keywords = {{Cardiovascular risk profile; Country of birth; Disparities; Immigrants; Myocardial infarction; Outcomes}},
language = {{eng}},
number = {{6}},
pages = {{507--522}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal - Quality of Care and Clinical Outcomes}},
title = {{Ma nagement a nd outcome in foreign-born vs native-born patients with myocardial infarction in Sweden}},
url = {{http://dx.doi.org/10.1093/ehjqcco/qcae020}},
doi = {{10.1093/ehjqcco/qcae020}},
volume = {{10}},
year = {{2024}},
}