Time Trends and Educational Inequalities in Out-of-Hospital Coronary Deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) Project

Enxhela Sulo; Ottar Nygård; Stein Emil Vollset; Jannicke Igland; Marta Ebbing; Truls Østbye; Torben Jørgensen; Gerhard Sulo; Grethe S Tell

doi:10.1161/JAHA.116.005236

Time Trends and Educational Inequalities in Out-of-Hospital Coronary Deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) Project

J Am Heart Assoc. 2017 Feb 20;6(2):e005236. doi: 10.1161/JAHA.116.005236.

Authors

Enxhela Sulo¹, Ottar Nygård^{2

3}, Stein Emil Vollset^{4

5}, Jannicke Igland⁴, Marta Ebbing^{4

6}, Truls Østbye^{4

7}, Torben Jørgensen^{8

9

10}, Gerhard Sulo⁴, Grethe S Tell^{4

6}

Affiliations

¹ Department of Global Public Health and Primary Care, University of Bergen, Norway enxhela.sulo@uib.no.
² Department of Clinical Science, University of Bergen, Norway.
³ Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
⁴ Department of Global Public Health and Primary Care, University of Bergen, Norway.
⁵ Centre for Burden of Disease, Norwegian Institute of Public Health, Bergen, Norway.
⁶ Domain for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway.
⁷ Duke Global Health Institute, Duke University, Durham, NC.
⁸ Research Centre for Prevention and Health, Capital Region, Denmark.
⁹ Department of Public Health, Institute of Clinical Science, University of Copenhagen, Denmark.
¹⁰ Faculty of Medicine, University of Aalborg, Denmark.

Abstract

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 (IRRs) and 95%CIs. Of 100 783 coronary heart disease deaths, 58.8% were OHCDs. 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.

Keywords: Norway; coronary artery disease; educational inequalities; epidemiology; mortality; out‐of‐hospital coronary; trends.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Distribution
Aged
Aged, 80 and over
Cardiovascular Diseases / mortality*
Cause of Death
Educational Status*
Female
Forecasting*
Humans
Incidence
Male
Middle Aged
Norway / epidemiology
Out-of-Hospital Cardiac Arrest / epidemiology*
Registries*
Retrospective Studies
Sex Distribution
Socioeconomic Factors
Survival Rate / trends
Time Factors