Open AccessTime Trends and Educational Inequalities in Out‐of‐Hospital Coronary Deaths in Norway 1995–2009: A Cardiovascular Disease in Norway ( CVDNOR ) Project
Author(s) -
Sulo Enxhela,
Nygård Ottar,
Vollset Stein Emil,
Igland Jannicke,
Ebbing Marta,
Østbye Truls,
Jørgensen Torben,
Sulo Gerhard,
Tell Grethe S.
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.116.005236
Subject(s) - medicine , poisson regression , rate ratio , demography , incidence (geometry) , confidence interval , mortality rate , pediatrics , gerontology , population , environmental health , physics , sociology , optics
Background Recent time trends and educational gradients characterizing out‐of‐hospital coronary deaths ( OHCD ) are poorly described. Methods and Results We identified all deaths from coronary heart disease occurring outside the hospital in Norway during 1995 to 2009. Time trends were explored using Poisson regression analysis with year as the independent, continuous variable. Information on the highest achieved education was obtained from The National Education Database and classified as primary (up to 10 years of compulsory education), secondary (high school or vocational school), or tertiary (college/university). Educational gradients in OHCD were explored using Poisson regression, stratified by sex and age (<70 and ≥70 years), and results were expressed as incidence rate ratios ( IRR s) and 95%CIs. Of 100 783 coronary heart disease deaths, 58.8% were OHCD s. From 1995 to 2009, age‐adjusted OHCD rates declined across all education categories (primary, secondary, and tertiary) in younger men ( IRR =0.35; 95% CI 0.32‐0.38; IRR =0.38; 95% CI 0.35‐0.42; IRR =0.33; 95% CI 0.28‐0.40), younger women ( IRR =0.47; 95% CI 0.40‐0.56; IRR =0.55; 95% CI 0.45‐0.67; IRR =0.28; 95% CI 0.16‐0.47), older men ( IRR =0.20; 95% CI 0.19‐0.22; IRR =0.20; 95% CI 0.18‐0.22; IRR =0.20; 95% CI 0.17‐0.23), and older women ( IRR =0.26; 95% CI 0.24‐0.28; IRR =0.25; 95% CI 0.23‐0.28; IRR =0.28; 95% CI 0.22‐0.34). Tertiary education was associated with lower risk of OHCD compared to primary education ( IRR =0.37; 95% CI 0.35‐0.40 in younger men, IRR =0.26; 95% CI 0.22‐0.30 in younger women, IRR =0.52; 95% CI 0.49‐0.55 in older men, and IRR =0.61; 95% CI 0.57‐0.66 in older women). These gradients did not change over time ( P interaction=0.25). Conclusions Although OHCD rates declined substantially during 1995 to 2009, they displayed educational gradients that remained constant over time.