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Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register

BMJ 1997; 314 doi: (Published 22 February 1997) Cite this as: BMJ 1997;314:541
  1. Caroline Morrison, consultant in public health medicinea,
  2. Mark Woodward, senior lecturer in statistical epidemiologyb,
  3. Wilma Leslie, senior research nursea,
  4. Hugh Tunstall-Pedoe, professorc
  1. a MONICA Project, Royal Infirmary, Glasgow G31 2ER
  2. b Department of Applied Statistics, PO Box 240, University of Reading, Reading RG6 6FN
  3. c Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY
  1. Correspondence to: Dr Morrison
  • Accepted 6 December 1996


Objective: To investigate the effect of socioeconomic group (with reference to age and sex) on the rate of, course of, and survival after coronary events.

Design: Community coronary event register from 1985 to 1991.

Setting: City of Glasgow north of the River Clyde, population 196 000.

Subjects: 3991 men and 1551 women aged 25-64 years on the Glasgow MONICA coronary event register with definite or fatal possible or unclassifiable events according to the criteria of the World Health Organisation's MONICA project (monitoring trends and determinants in cardiovascular disease).

Main outcome measures: Rate of coronary events; proportion of subjects reaching hospital alive; case fatality in admitted patients and in community overall.

Results: Event rates increased with age for both sexes and were greater in men than women at all ages. The rate increased 1.7-fold in men and 2.4-fold in women from the least (Q1) to the most (Q4) deprived socioeconomic quarter. The socioeconomic gradient decreased with age and was steeper for women than men. The proportion treated in hospital (66%) decreased with age, was greater in women than men, and decreased in both sexes with increasing deprivation (age standardised odds ratio 0.82 for Q4 v Q1) Case fatality in hospital (20%) increased with age, was greater for women than men when age was standardised, and showed no strong socioeconomic pattern. Overall case fatality in the community (50%) increased with age, was similar between the sexes, and increased from Q1 to Q4 (age standardised odds ratio 1.12 in men, 1.18 in women).

Conclusions: Socioeconomic group affects not only death rates from myocardial infarction but also event rates and chance of admission. This should be taken into account when different groups of patients are compared. Because social deprivation is associated with so many more deaths outside hospital, primary and secondary prevention are more likely than acute hospital care to reduce the socioeconomic variation in mortality.

Key messages

  • Socioeconomic variation in rates of coronary events was greater for women than men

  • The largest social class gradient was in the proportion of deaths occurring outside hospital

  • Overall, 68% of all people who died of coronary events did so before admission

  • Acute hospital care applied to only 66% of all cases and therefore could affect only 32% of all deaths

  • Reduction in socioeconomic variation in mortality from coronary disease is best addressed by reducing the variation of event rates-that is, by primary and secondary prevention

  • Allocation of resources for reduction of coronary mortality should take account of social class differences and the relative potential effect of hospital care and primary and secondary prevention


  • Funding The Scottish MONICA project was funded by grants from the Chief Scientist Office of the Scottish Office Home and Health Department.

  • Conflict of interest None.

  • Accepted 6 December 1996
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