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Published on: March 19, 2018
Ethnic differences in acute myocardial infarction in Singapore
Aims:
We compare the myocardial infarction (MI) event and mortality rates among Chinese, Malay and Indian residents of Singapore.
Methods:
Residents, aged 20 to 64 years, with an MI event were identified from hospital discharge listings, postmortem reports, and the Registry of Births and Deaths. All pathology laboratories flagged patients with elevated creatine phosphokinase (CPK) levels. Modified MONICA (multinational monitoring of trends and determinants in cardiovascular disease) criteria were used for determining MI events.
Results:
From 1991 to 1999, 12 481 MI events were identified. Chinese patients were older and less likely to have typical symptoms or previous MI. Malays had the highest peak CPK level. Among all three ethnic groups, MI event and age-adjusted case-fatality rates declined. Compared with Chinese, MI event rates were >2-fold and >3-fold higher, and age-standardized coronary mortality rates were 2.4 and 3.0 higher times for Malays and Indians, respectively. Malays have the highest 3.1-year case-fatality, with an adjusted hazard ratio of 1.26 (95% confidence interval, 1.14 to 1.38) compared with Chinese.
Conclusion:
We found strong ethnic differences in MI event, case-fatality and coronary mortality rates among the three ethnic groups in Singapore. While Indians have the greatest MI event rates, Malays have the highest case-fatality.
Insights
Ethnic differences in myocardial infarction (MI) rates were observed in Singapore. Indians had the highest MI event rates, while Malays experienced the highest case-fatality, highlighting significant disparities in cardiovascular disease outcomes.
Area of Science:
- Cardiovascular Epidemiology
- Public Health
- Ethnic Health Disparities
Background:
- Myocardial infarction (MI) is a leading cause of mortality globally.
- Understanding ethnic variations in MI incidence and outcomes is crucial for targeted public health interventions.
Purpose of the Study:
- To compare myocardial infarction (MI) event and mortality rates among Chinese, Malay, and Indian residents in Singapore.
- To identify ethnic disparities in cardiovascular disease outcomes within a multi-ethnic population.
Main Methods:
- Retrospective analysis of MI events (1991-1999) using hospital discharge data, postmortem reports, and birth/death registries.
- Inclusion criteria: residents aged 20-64 with an MI event.
- Modified MONICA criteria applied for MI event determination; elevated creatine phosphokinase (CPK) levels flagged by pathology labs.
Main Results:
- A total of 12,481 MI events were identified.
- Compared to Chinese, Malay and Indian residents showed significantly higher MI event rates (>2-fold and >3-fold, respectively).
- Indians had the highest MI event rates, while Malays exhibited the highest 3.1-year case-fatality (adjusted hazard ratio 1.26).
Conclusions:
- Significant ethnic disparities exist in myocardial infarction (MI) event rates, case-fatality, and coronary mortality in Singapore.
- Indians face the highest risk of MI events, whereas Malays bear the highest burden of MI case-fatality.
- These findings underscore the need for culturally tailored cardiovascular disease prevention and management strategies.
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