Background
Ischaemic heart disease mortality rates are higher in Māori and Pacific compared to European people. We aimed to explore the extent to which differences in the clinical presentation, cardiovascular risk factors, comorbidity and in-hospital treatment can explain the divergence in outcomes between ethnic groups in patients presenting with their first myocardial infarct (MI).
Methods
New Zealand residents (≥20 years old) hospitalised with their first MI (2014-2017), and who underwent coronary angiography, were identified from the All NZ Acute Coronary Syndrome Quality Improvement registry.
Results
Of the 17,404 patients, European/other comprised 76% of the population, Māori 11.5%, Pacific 5.1%, Indian 4.3% and other Asian 2.9%. Māori and Pacific patients had a greater burden of cardiovascular risk factors, and were more likely to present with heart failure and advanced coronary disease. After adjustment for age-group and sex, Māori and Pacific had significantly higher all-cause mortality (HR 2.55, (95%CI 2.12–3.07) HR 2.98, (95%CI 2.34–3.81), compared with European/others. When adjusted for differences in clinical presentation, clinical history and cardiovascular risk factors the excess mortality risk for Māori and Pacific patients was significantly reduced, but a differential persisted (HR 1.77, (95%CI 1.44–2.19), HR 1.42, (95%CI 1.07–1.83)), which was not further reduced by adjustment for differences in treatment.
Conclusion
In NZ patients after their first MI there is a three-fold variation in 1-year mortality based on ethnicity. At least half of the inequity in outcomes for Māori, and three-quarters for Pacific people, is associated with differences in potentially modifiable clinical factors.
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Identification
Copyright
© 2020 Published by Elsevier Inc.
