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Acute myocardial infarction incidence in immigrants to Sweden. Country of birth, time since immigration, and time trends over 20 years

  • Cardiovascular Disease
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Abstract

This study investigates incidence of first acute myocardial infarction (MI) among foreign born persons in Sweden using case control methods, taking into consideration country of birth, gender, socio-economic group and time since immigration and evaluates if the decreasing incidence of MI in Sweden during the study period was also present in immigrants. The study base consisted of persons 30–74 years of age in Stockholm County 1977–96. All incident cases of first acute MI in the study population were identified using registers of hospital discharges and deaths. Controls were selected randomly from the study base and the sampling fractions were known, enabling estimates of person time at risk. Foreign born subjects had a higher incidence of MI than subjects born in Sweden (men RR[Relative risk]=1,17; 95% CI 1,13–1,21; women RR = 1,15; 95% CI 1,09–1,21) after adjustment for calendar year, age and socio-economic group. An increased incidence was present primarily in subjects born in Finland, other Nordic countries, Poland, Turkey, Syria and South Asia in both genders, from the Netherlands among men and from Iraq among women and was still present after more than 20 years in Sweden. The incidence rate of MI 1977–96 among foreign born persons followed the general decline in the Swedish population. We conclude that foreign born persons in Sweden have an increased incidence of first MI which persists several years after immigration and is not explained by socio-economic differences. It is likely that this to an important extent has a background in factors in the country of origin.

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Acknowledgements

This study was financially supported by the Swedish Council for Working Life and Social Research (grant no 2001-1133) and the Stockholm County Council.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Ebba Hedlund & Niklas Hammar

  2. Centre for Research in Migration and Ethnic Relations, Stockholm University, 106 91, Stockholm, Sweden

    Ebba Hedlund & Anders Lange

Authors
  1. Ebba Hedlund
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  2. Anders Lange
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  3. Niklas Hammar
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Corresponding author

Correspondence to Ebba Hedlund.

Appendices

Appendix 1

Except for individual countries, the following geographical categorisations of countries of birth have been used through out the paper:

The Baltic States: Estonia, Lithuania, Latvia

Other Nordic countries: Denmark, Norway, Iceland

Former Yugoslavia: Bosnien-Hercegovina, Yugoslavia, Croatia, Macedonia

Eastern Europe: Albania, Bulgaria, Romania, Czechoslovakia, East Germany

Western Europe: Belgium, Switzerland, Austria,

Western Europe and North America: Belgium, Switzerland, Austria + North America

Sub-Saharan Africa: Angola, Botswana, Burundi, Central African Republic, Comoros, French Equatorial Africa, Ivory Coast, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Cameroon, Cape Verde, Kenya, People’s Rep of Congo, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Seychelles, Sierra Leone, Somalia, Sudan, Swaziland, South Africa, Tanzania, Chad, Togo, Uganda, Zaire, Zambia, Zanzibar

North Africa: Algeria, Libya, Morocco, Tunisia

Africa: Sub-Saharan Africa + North Africa

North America: USA, Canada

South Asia: India, Pakistan, Bangladesh

South East Asia: Burma, Kampuchea, Philippines, Hong Kong, Indonesia, Japan, People’s Rep of China, China (Taiwan), North Korea, South Korea, Laos, Malaysia, Singapore, Sri Lanka, Thailand, Vietnam

Asia: South Asia + South East Asia

Mediterranean countries: Greece + Other Mediterranean countries

Other Mediterranean countries: Italy, Portugal, Spain, Cyprus, Malta, Monaco, France

Other South American and Caribbean countries: Argentina, Bolivia, Brazil, Colombia, Costar Rica, Ecuador, El Salvador, Guatemala, Guyana, Jamaica, Trinidad & Tobago, Honduras, Nicaragua, Panama, Haiti, Mexico, Paraguay, Peru, Surinam, Uruguay, Venezuela, Barbados, Cuba, Dominica

South America and Caribbean countries: Chile + Other South American countries

Other Middle Eastern countries: Egypt, Israel, Jordan, Saudi Arabia, Yemen, Kuwait, Lebanon, Palestine, Afghanistan

Middle Eastern countries: Turkey, Syria, Iran, Iraq, + Other Middle Eastern countries

Former Soviet Union: Armenia, Azerbaijan, Kazakhstan, Russia, Ukraine, Belarus (not including the Baltic States)

Appendix 2:

Based on data from WHO Global InfoBase: www.who.int/ncd_surveillance/infobase

Age-standardised mortality in IHD/100,000 persons

Country of birth

Men

Women

Age-standardised mortality in IHD in country of birth, number of deaths / 100,000 in 2002

Relative risk of IHD mortality in country of birth in 2002

Age-standardised mortality in IHD in country of birth, number of deaths / 100,000 in 2002

Relative risk of IHD mortality in country of birth in 2002

Sweden

124

1

58

1

Nordic countries

Denmark

121

1,0

60

1,0

Finland

173

1,4

81

1,4

Norway

125

1,0

59

1,0

Eastern Europe

Bosnia-Herzegovina

166

1,3

81

1,4

Estonia

377

3,0

186

3,2

Hungary

237

1,9

131

2,3

Latvia

355

2,9

174

3,0

Lithuania

360

2,9

187

3,2

Poland

204

1,6

93

1,6

Romania

232

1,9

147

2,5

Russian Federation

501

4,0

238

4,1

Western Europe

Austria

125

1,0

66

1,1

Belgium

102

0,8

44

0,8

NL

99

0,8

43

0,8

Switzerland

92

0,7

45

0,8

UK

140

1,1

66

1,1

Germany

134

1,1

68

1,2

Mediterranean countries

France

56

0,5

26

0,5

Greece

105

0,8

49

0,8

Italy

95

0,8

46

0,8

Portugal

82

0,7

42

0,7

Spain

78

0,6

34

0,6

North America

Canada

114

0,9

54

 

USA

140

1,1

77

1,3

Latin America and Caribbean countries

Argentina

117

0,9

48

0,8

Bolivia

114

0,9

74

1,3

Brazil

146

1,2

94

1,6

Chile

90

0,7

42

0,7

Colombia

139

1,1

92

1,6

Ecuador

94

0,8

55

0,9

Mexico

100

0,8

65

1,1

Uruguay

114

0,9

48

0,8

Asia

Bangladesh

245

2,0

194

3,3

Cambodia

170

1,4

118

2,0

China

74

0,6

63

1,1

India

268

2,2

198

3,4

Indonesia

194

1,6

144

2,5

Japan

47

0,4

21

0,4

Laos

260

2,1

194

3,3

Malaysia

123

1,0

83

1,4

Pakistan

259

2,1

198

3,4

Philippines

154

1,3

97

1,7

Srilanka

130

1,0

78

1,3

Sydkorea

49

0,4

28

0,5

Thailand

74

0,6

56

1,0

Vietnam

158

1,3

107

1,8

North Africa

Algeria

111

0,9

87

1,5

Libya

251

2,0

157

2,7

Morocco

236

1,9

168

2,9

Tunisia

241

1,9

171

2,9

Sub-Saharan Africa

Angola

184

1,5

133

2,3

Botswana

142

1,1

102

1,8

Burkina Faso

165

1,3

131

2,3

Burundi

149

1,2

127

2,2

Centr. Afr. Rep.

161

1,3

126

2,2

Chad

157

1,3

127

2,2

Cote d’Ivoire

163

1,3

119

2,1

Dem. Rep. Congo

166

1,3

132

2,3

Egypt

315

2,5

233

4,0

Ethiopia

147

1,2

127

2,2

Kenya

143

1,2

114

2,0

Somalia

264

2,1

209

3,6

South Africa

159

1,3

99

1,7

Sudan

233

1,9

178

3,1

Uganda

150

1,2

120

2,1

Middle Eastern countries

Afghanistan

427

3,4

280

4,8

Iran

278

2,2

199

3,4

Iraq

288

2,3

218

3,8

Jordan

251

2,0

153

2,6

Lebanon

264

2,1

191

3,3

Syria

225

1,8

134

2,3

Turkey

265

2,1

188

3,2

  1. All ages

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Hedlund, E., Lange, A. & Hammar, N. Acute myocardial infarction incidence in immigrants to Sweden. Country of birth, time since immigration, and time trends over 20 years. Eur J Epidemiol 22, 493–503 (2007). https://doi.org/10.1007/s10654-007-9147-9

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