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Published on: May 28, 2019
Ethnic Differences and Trends in ST-Segment Elevation Myocardial Infarction Incidence and Mortality in a Multi-Ethnic
Huili Zheng1, Pin Pin Pek, Andrew Fw Ho
1National Registry of Diseases Office, Health Promotion Board, Singapore.
Insights
Malays and Indians have higher ST-segment elevation myocardial infarction (STEMI) incidence than Chinese in Singapore. Ethnic disparities in STEMI mortality risk largely attenuated after adjustments, except for Malays.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- ST-segment elevation myocardial infarction (STEMI) affects diverse ethnic groups.
- Understanding ethnic disparities in STEMI incidence and outcomes is crucial for targeted public health interventions.
Purpose of the Study:
- To compare STEMI incidence and mortality rates among Singapore's three main ethnic groups (Chinese, Malays, Indians).
- To analyze trends in STEMI incidence and mortality over time.
- To identify factors contributing to ethnic disparities in STEMI outcomes.
Main Methods:
- Analysis of 16,983 consecutive STEMI patients from Singaporean public hospitals (2007-2014).
- Comparison of incidence rates per 100,000 population across ethnic groups.
- Assessment of 30-day and 1-year all-cause mortality rates.
- Statistical adjustment for demographics, comorbidities, and primary percutaneous coronary intervention (PCI).
Main Results:
- Malays (114/100,000) and Indians (126/100,000) showed higher STEMI incidence than Chinese (58/100,000) in 2014.
- Malay STEMI incidence slightly increased, while Chinese and Indian rates remained stable.
- Higher 30-day and 1-year mortality observed in Chinese and Malays compared to Indians, but disparities attenuated after adjustments, except for Malays' 1-year mortality.
Conclusions:
- Continuous evaluation of STEMI management programs is necessary due to evolving etiology.
- Balancing prevention and treatment efforts is key.
- Addressing ethnic disparities in STEMI outcomes requires tailored strategies within resource constraints.
Introduction:
This study aimed to compare the incidence and mortality of ST-segment elevation myocardial infarction (STEMI) across the 3 main ethnic groups in Singapore, determine if there is any improvement in trends over the years and postulate the reasons underlying the ethnic disparity.
Materials And Methods:
This study consisted of 16,983 consecutive STEMI patients who sought treatment from all public hospitals in Singapore from 2007 to 2014.
Results:
Compared to the Chinese (58 per 100,000 population in 2014), higher STEMI incidence rate was consistently observed in the Malays (114 per 100,000 population) and Indians (126 per 100,000 population). While the incidence rate for the Chinese and Indians remained relatively stable over the years, the incidence rate for the Malays rose slightly. Relative to the Indians (30-day and 1-year all-cause mortality at 9% and 13%, respectively, in 2014), higher 30-day and 1-year all-cause mortality rates were observed in the Chinese (15% and 21%) and Malays (13% and 18%). Besides the Malays having higher adjusted 1-year all-cause mortality, all other ethnic disparities in 30-day and 1-year mortality risk were attenuated after adjusting for demographics, comorbidities and primary percutaneous coronary intervention.
Conclusion:
It is important to continuously evaluate the effectiveness of existing programmes and practices as the aetiology of STEMI evolves with time, and to strike a balance between prevention and management efforts as well as between improving the outcome of "poorer" and "better" STEMI survivors with finite resources.
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