European Journal of Clinical Pharmacology

, Volume 66, Issue 7, pp 735–742 | Cite as

Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study

  • Nana Folmann HemplerEmail author
  • Finn Diderichsen
  • Finn Breinholt Larsen
  • Steen Ladelund
  • Torben Jørgensen
Pharmacoepidemiology and Prescription



We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin and medical treatment were mediated by socioeconomic status (SES).


This register-based follow-up study consisted of individuals >17 years of age, admitted to hospital with AMI between 2001 and 2005 (n = 25 443). Danish-born residents were compared with immigrants from Turkey, Pakistan and Yugoslavia. Individuals were identified by civil registration number, and data were obtained through linkage to the national registers of hospitalisations and drug prescriptions. Odds of initiating treatment and hazard ratios (HR) of terminating treatment were estimated. Mediators such as income and employment were included in the models.


Pakistanis were less likely than Danish-born residents to initiate treatment with beta-blockers after AMI [odds ratio 0.52; 95% confidence interval (CI) 0.34–0.80]. Immigrants from Turkey (HR 1.36; 95% CI 1.07–1.73) and Pakistan (HR 1.59; 95% CI 1.21–2.08) were more likely to terminate treatment with beta-blockers before being recommended to do so. Estimates did not change markedly when income and education were included in the models.


The results of this study suggest that immigrants from Pakistan and Turkey do not receive adequate medical treatment with beta-blockers after a first AMI compared with Danish-born residents. Mediators such as income and employment may not be sufficient indicators of SES when the effect of patient origin on medical treatment is explored. A lower SES of immigrants, communication problems between doctor and patient and doctors’ attitudes towards immigrants may explain ethnic differences in medical treatment after AMI.


Acute myocardial infarction Beta-blockers Immigrants Socioeconomic status Statins 



This study was supported by grants from The Danish Heart Foundation and Helsefonden.

Competing interests

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Nana Folmann Hempler
    • 1
    Email author
  • Finn Diderichsen
    • 3
  • Finn Breinholt Larsen
    • 4
  • Steen Ladelund
    • 2
  • Torben Jørgensen
    • 2
  1. 1.Research Centre for Prevention and Health, Capital Region of DenmarkGlostrup University HospitalGlostrupDenmark
  2. 2.Research Centre for Prevention and Health, Capital Region of DenmarkGlostrup University HospitalGlostrupDenmark
  3. 3.Department of Social Medicine, Institute of Public HealthUniversity of CopenhagenCopenhagen KDenmark
  4. 4.Centre of Public Health, Central Denmark RegionAarhus NDenmark

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