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Complex impact of remoteness on the incidence of myocardial infarction in A boriginal and non‐ A boriginal people in W estern A ustralia
Author(s) -
Katzenellenbogen Judith M.,
Sanfilippo Frank M.,
Hobbs Michael S. T.,
Briffa Tom G.,
Knuiman Matthew W.,
Dimer Lyn,
Thompson Peter L.,
Thompson Sandra C.
Publication year - 2012
Publication title -
australian journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.48
H-Index - 49
eISSN - 1440-1584
pISSN - 1038-5282
DOI - 10.1111/j.1440-1584.2012.01314.x
Subject(s) - myocardial infarction , incidence (geometry) , demography , medicine , confidence interval , metropolitan area , disadvantaged , disadvantage , rate ratio , pathology , physics , sociology , political science , law , optics
Objective To determine the impact of remoteness on A boriginal and non‐ A boriginal myocardial infarction incidence rates in men and women of different ages. Design Descriptive study. Setting W estern A ustralia. Participants Incident cases of myocardial infarction in W estern A ustralia from 2000–2004 identified from person‐linked files of hospital and mortality records. Analysis was undertaken for A boriginal and non‐ A boriginal populations, separately and combined, by broad age group, sex and remoteness. Main outcome measure Incidence of myocardial infarction. Results In the combined analysis, age‐standardised incidence was significantly higher for men in very remote areas (rate ratio 1.31: 95% confidence interval ( CI ), 1.19–1.45) and in women in both regional (rate ratio 1.12: 95% CI , 1.01–1.20) and very remote (rate ratio 2.05: 95% CI , 1.75–2.41) areas. A boriginal rates were substantially higher than non‐ A boriginal rates in all substrata. Compared with metropolitan people, regional A boriginal men and very remote non‐ A boriginal men aged 25–54 years had significantly higher incidence rates. For the remaining rural strata, there was either no geographical disadvantage or inconclusive findings. Conclusions Non‐metropolitan disadvantage in myocardial infarction rates is confirmed in regional areas and women in very remote areas. This disadvantage is partly explained by the high rates in A boriginal people. Non‐metropolitan dwellers are not uniformly disadvantaged, reflecting the interplay of the many factors contributing to the complex relationship between myocardial infarction incidence and sex, age, A boriginality and residence. Aboriginal W estern A ustralians in all regions and young non‐ A boriginal men living in very remote areas need to be targeted to reduce disparities in myocardial infarction.