Skip to main content
SpringerLink
Log in

Ethnic differences in mortality of male and female patients surviving acute myocardial infarction: Long-term follow-up of 5,700 patients

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

In migrant countries, ethnic origin may represent a complex of cultural, behavioral and possibly genetic differences. These have been shown to influence acute myocardial infarction (AMI) incidence. How ethnic origin may affect survival after AMI is unknown. Data from 5,692 patients included in the Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) registry were analyzed. Patients were divided into eight different ethnic groups, according to birthplaces from five continents, representing major socio-economic and possibly some genetic variation. Mortality was analyzed after adjustment for baseline characteristics known to predict death from coronary artery disease (CAD) using Jews born in Israel as a reference. The odds ratio for in-hospital mortality was higher in women than in men, but unrelated to ethnic origin. The odds ratio for men ranged between 1.08 (95% confidence interval (CI): 0.67–1.73) for Jews born in Eastern Europe and 1.84 (95% CI: 1.07–3.15) for counterparts born in the Middle East. The odds ratio for women ranged between 0.73 in Jews born in Central Europe (95% CI: 0.35–1.50) and 1.45 (95% CI: 0.76–3.15) for Jewish women born in the Balkan countries. Among 4,686 patients surviving the hospital phase, long-term mortality rates (mean follow-up 7.1 ± 3.5 years) were 43.3% in men and 57.6% in women. Among 3,586 surviving men, the adjusted risk ratios for 10-year mortality varied between 0.92 (95% CI: 0.72–1.18) for men born in Romania and 1.49 (95% CI: 1.07–2.09) for Israeli born Arabs. The variation among men is within the limits of statistical error. However, among 1,100 surviving women, the risk ratio for 10-year mortality differed significantly, from as low as 1.43 (95% CI: 0.84–2.41) in Jewish women born in Central Europe to as high as 2.83 (95% CI: 1.67–4.79) in counterparts born in the Middle East. The latter observations were consistent with the mortality after 3 years. Thus, ethnic origin of Israelis marginally influenced the in-hospital mortality. The long-term prognosis varied significantly among women from different origins but not among men.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goldbourt U. Differences of frequency of atherosclerosis and coronary heart disease between populations and ethnic groups. In: Goldbourt U, de Faire U, Berg K (eds), Genetic factors in coronary heart disease. Dordrecht/Boston/Lancaster: Kluwer Academic Publishers, 1994: 3–20.

    Google Scholar 

  2. Medalie JH. Classification of Israeli Jews for medical-scientific purposes. Isr Med J 1962; 21: 118–126.

    Google Scholar 

  3. Medalie JH Kahn HA, Neufeld HN, Riss E, Goldbourt U. Five year myocardial infarction incidence: I. Prevalence, incidence and mortality. J Chron Dis 1973; 26: 63–84.

    Google Scholar 

  4. Goldbourt U, Yaari S, Medalie JH. Factors predictive of long-term coronary heart disease mortality among 10,059 male Israeli civil servants and municipal employees. Cardiology 1993; 82: 100–121.

    Google Scholar 

  5. Goldbourt U, Neufeld HN. Trends in coronary heart disease mortality and related factors in Israel. Cardiology 1985; 72: 63–74.

    Google Scholar 

  6. Douglas PS. Gender, cardiology, and optimal medical care (editorial). Circulation 1986; 74: 917–919.

    Google Scholar 

  7. Greenland P, Reicher-Reiss H, Goldbourt U, Behar S, and the Israeli SPRINT Investigators. In-hospital and 1-year mortality in 1,524 women after myocardial infarction; Comparison with 4,315 men. Circulation 1991; 83: 484–491.

    Google Scholar 

  8. Wenger NK. Coronary disease in women. Ann Rev Med 1985; 36: 285–294.

    Google Scholar 

  9. Puletti M, Sunseri L, Curione M, Erba SM, Borgia C. Acute myocardial infarction: Sex related differences in prognosis. Am Heart J 1984; 108: 63–66.

    Google Scholar 

  10. Gomez-Marin O, Folsom AR, Kottke TE, Wu S-CH, Jacobs DR Jr, Gillum RF, Edlavitch SA, Blackburn H. Improvement in long-term survival among patients hospitalized with acute myocardial infarction. 1970 to 1980. N Engl J Med 1987; 316: 1353–1359.

    Google Scholar 

  11. Tofler GH, Stone PH, Muller JE, Willich SN, Davis VG, Poole WK, Strauss HW, Willerson JT, Jaffe AS, Robertson T, Passamani E, Braunwald E, MILIS Study Group. Effects of gender and race on prognosis after myocardial infarction: Adverse prognosis for women, particularly black women. J Am Coll Cardiol 1987; 9: 473–482.

    Google Scholar 

  12. Dittrich H, Gilpin E, Nicod P, Cali G, Henning H, Ross J Jr. Acute myocardial infarction in women: Influence of gender on mortality and prognostic variables. Am J Cardiol 1988; 62: 1–7.

    Google Scholar 

  13. Norris RM, Caughey DE, Deeming LW, Mercer CJ, Scott PJ. Coronary prognostic index for predicting survival after recovery from acute myocardial infarction. Lancet 1970; 2: 485–488.

    Google Scholar 

  14. Weinblatt E, Shapiro S, Frank CW. Prognosis of women with newly diagnosed coronary artery disease: A comparison with course of disease among men. Am J Public Health 1973; 63: 577–593.

    Google Scholar 

  15. Helmers C. Short and long-term prognosis in acute myocardial infarction. Acta Med Scand 1974; 555(suppl): 1–86.

    Google Scholar 

  16. Elveback LR, Connolly DC. Coronary heart disease in residents of Rochester, Minnesota: V. Prognosis of patients with coronary heart disease based on initial manifestation. Mayo Clin Proc 1985; 60: 305–311.

    Google Scholar 

  17. Kiel JE, Sutherland SE, Knapp RG, Lackland DT, Games PC, Tyroler HA. Mortality rates and risk factors for coronary disease in black as compared with white men and women. N Engl J Med 1993; 329: 73–78.

    Google Scholar 

  18. Johansson S, Bergstrand R, Ulvenstam G, Vedin A, Wilhelmsson C, Wedel H, Wilhelmsen L, Aberg A. Sex differences in preinfarction characteristics and long-term survival among patients with myocardial infarction. Am J Epidemiol 1984; 119: 610–623.

    Google Scholar 

  19. Merrilees MA, Scott PJ, Norris RM. Prognosis after myocardial infarction: Results of 15 year follow up. Br Med J 1984; 288: 356–359.

    Google Scholar 

  20. Saito M, Fukami KI, Hiramori K, Haze K, Sumiyoshi T, Kasagi H, Horibe H. Long-term prognosis of patients with acute myocardial infarction: Is mortality and morbidity as low as the incidence of ischemic heart disease in Japan? Am Heart J 1987; 113: 891–897.

    Google Scholar 

  21. Wong ND, Cupples LA, Ostfeld AM, Levy D, Kannel WB. Risk factors for long term coronary prognosis after initial myocardial infarction. The Framingham Study. Ann J Epidemiol 1989; 130: 469–480.

    Google Scholar 

  22. The Israeli SPRINT Study Group. Secondary prevention reinfarction Israeli nifedipine trial (SPRINT). A randomized interventional trial of nifedipine in patients with acute myocardial infarction. Eur Heart J 1988; 8: 354–364.

    Google Scholar 

  23. Prineas RJ, Crow RS, Blackburn H. The Minnesota Code Manual of Electrocardiographic Findings, Standards and Procedures for Measurements and Classification. Littleton, Massachusetts: John Wright, 1982.

    Google Scholar 

  24. LOGISTIC procedure. SAS/STAT User's Guide, version 6, 4th ed. vol. 1. Cary, NC: SAS Institute, 1989: 372.

    Google Scholar 

  25. The PHREG Procedure, Preliminary Documentation. SAS/STAT software. Cary, NC: SAS Institute, 1991: 1–59.

  26. Dreyfus F. Incidence of myocardial infarction in various communities in Israel. Am Heart J 1953; 45: 749–755.

    Google Scholar 

  27. Toor M, Katchalsky A, Agmon J, Allalouf D. Atherosis and related factors in immigrants to Israel. Circulation 1960; 22: 265–279.

    Google Scholar 

  28. Ungar H, Laufer A. Necropsy survey of atherosclerosis in the Jewish population of Israel: Preliminary report. Pathol Microbiol (Basel) 1961; 24: 711–717.

    Google Scholar 

  29. Goldbourt U, Kark JD. The epidemiology of coronary heart disease in the ethnically and culturally diverse population of Israel. Isr J Med Sci 1982; 18: 1077–1097.

    Google Scholar 

  30. Central Bureau of Statistics. Causes of death, 1974. Special series no. 522, Jerusalem, 1976.

  31. Kark SL. Variation in sex ratio in cardiovascular mortality: A comparative analysis of mortality in adults of different populations. Isr J Med Sci 1976; 12: 1194–1206.

    Google Scholar 

  32. Neufeld HN, Goldbourt U. Coronary heart disease: Genetic aspects. Circulation 1983; 67: 943–954.

    Google Scholar 

  33. Norris SL, deGuzman M, Sobel E, Brooks S, Haywood LJ. Risk factors and mortality among black, Caucasian, and Latina women with acute myocardial infarction. Am Heart J 1993; 126: 1313–1319.

    Google Scholar 

  34. Harris RB, Weissfeld LA. Gender differences in the reliability of reporting symptoms of angina pectoris. J Clin Epidemiol 1991; 44: 1071–1078.

    Google Scholar 

  35. Eisenstadt SN. The absorption of immigrants. London: Routledge and Kegan, 1954.

    Google Scholar 

  36. Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: A review of the literature. Circulation 1993; 88: 1973–1998.

    Google Scholar 

  37. Tofler HG, Muller JE, Stone PH, Davies G, Davis VG, Braunwald E and the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Am J Cardiol 1993; 71: 1031–1035.

    Google Scholar 

Download references

Authors
  1. David Harpaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Wolfson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Harpaz, D., Wolfson, E. Ethnic differences in mortality of male and female patients surviving acute myocardial infarction: Long-term follow-up of 5,700 patients. Eur J Epidemiol 13, 745–754 (1997). https://doi.org/10.1023/A:1007400419922

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007400419922

Search

Navigation