Socioeconomic inequalities in acute myocardial infarction incidence in migrant groups: has the epidemic arrived? Analysis of nation-wide data

Charles O Agyemang · Aloysia A. M. van Oeffelen · Michiel L. Bots · Karien Stronks · Ilonca C. H. Vaartjes

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Health disparities and outcomes Acute Myocardial Infarction Research Cardiovascular Health and Risk Factors

Abstract

OBJECTIVES: We assessed socioeconomic inequalities in relation to acute myocardial infarction (AMI) incidence among major ethnic groups in The Netherlands. METHODS: A nationwide register-based cohort study was conducted (n=2 591 170) between 1 January 1998 and 31 December 2007 among ethnic Dutch and migrant groups from Suriname, Netherlands Antilles, Indonesia, Morocco and Turkey. Standardised household disposable income was used as a proxy for socioeconomic position. Cox proportional hazard models were used to estimate the socioeconomic inequalities in AMI incidence. RESULTS: Among ethnic Dutch, the AMI incidence was higher in the low-income group than in the high-income group: adjusted HRs were 2.05 (95% CI 2.00 to 2.10) for men and 2.33 (95% CI 2.23 to 2.43) for women. Importantly, similar socioeconomic inequalities in AMI incidence were also observed in all minority groups, with the low socioeconomic group having a higher AMI incidence than the high socioeconomic group: adjusted HR ranging from 2.07 (95% CI 1.26 to 3.40) in Moroccans to 2.73 (95% CI 1.55 to 4.80) in Antilleans in men; and from 2.17 (95% CI 1.74 to 2.71) in Indonesians to 3.88 (95% CI 2.36 to 6.38) in Turks in women. CONCLUSIONS: Our findings demonstrate socioeconomic inequalities in AMI incidence in migrant groups and suggest a convergence towards the Dutch general population. If the AMI incidence rates of the low socioeconomic group could be reduced to the level of the high socioeconomic group, this would represent a major public health improvement for all ethnic groups.

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References

1993Socioeconomic factors and cardiovascular disease: a review of the literature.2012WHO European review of social determinants of health and the health divide 2017Why are Some People Healthy and Others Not?2003The Structuring of Ethnic Inequalities in Health: Economic Position, Racial Discrimination, and Racism 2006Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice 2000Socioeconomic inequalities in cardiovascular disease mortality. An international study 1990Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study.2008The utility of ‘country of birth’ for the classification of ethnic groups in health research: the Dutch experience

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