Imperial College London
Alternate

ProfessorDarrelFrancis

Faculty of Medicine, National Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7594 3381d.francis Website

 
 
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Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Asaria:2022:10.1016/S2468-2667(22)00108-6,
author = {Asaria, P and Bennett, J and Elliott, P and Rashid, T and Daby, H and Douglass, M and Francis, D and Fecht, D and Ezzati, M},
doi = {10.1016/S2468-2667(22)00108-6},
journal = {The Lancet Public Health},
pages = {e813--e824},
title = {Contributions of event rates, pre-hospital deaths and hospital case fatality to variations in myocardial infarction mortality in 326 districts in England: spatial analysis of linked hospitalisation and mortality data},
url = {http://dx.doi.org/10.1016/S2468-2667(22)00108-6},
volume = {7},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Myocardial infarction (MI) mortality varies substantially within high-income countries. There is limited guidance on what interventions – primary and secondary prevention and/or improving care pathways and quality – can reduce and equalise MI mortality. Our aimwas to understand the contribution of incidence (event rate), pre-hospital deaths and hospital case-fatality, to how MI mortality varies within England.Methods: We used linked data on hospitalisation and deaths from 2015-2018 with geographical identifiers to estimate MI death and event rates, pre-hospital deaths and hospital case fatality for men and women aged 45 years and older in 326 districts in England. Data were analysed in a Bayesian spatial model that accounted for similarities and differences inspatial patterns of fatal and non-fatal MI. Results: The 99th to 1st percentile ratio of age-standardised MI death rate was 2.63 (95% credible interval 2.45-2.83) in women and 2.56 (2.37-2.76) in men across districts, with death rate highest in north of England. The main contributor to this variation was MI event rate, with a 99th to 1st percentile ratio of 2.55 (2.39-2.72) (women) and 2.17 (2.08-2.27) (men) across districts. Pre-hospital mortality was greater than hospital case fatality in every district. Prehospital mortality had a 99th to 1st percentile ratio 1.60 (1.50-1.70) in women and 1.75 (1.66-1.86) in men across districts and made a greater contribution to case-fatality variation thanhospital case fatality which had a 99th to 1st percentile ratio of 1.39 (1.29-1.49) (women) and1.49 (1.39-1.60) (men). The contribution of case fatality to variation in deaths across districtswas largest in middle ages. Pre-hospital mortality was slightly higher in men than women inmost districts and age groups, whereas hospital case fatality was higher in women in virtuallyall districts at ages up to and including 65-74 years; after this age, it became similar betweenthe sexes.3Interpretation: Mos
AU  - Asaria,P
AU  - Bennett,J
AU  - Elliott,P
AU  - Rashid,T
AU  - Daby,H
AU  - Douglass,M
AU  - Francis,D
AU  - Fecht,D
AU  - Ezzati,M
DO  - 10.1016/S2468-2667(22)00108-6
EP  - 824
PY  - 2022///
SN  - 2468-2667
SP  - 813
TI  - Contributions of event rates, pre-hospital deaths and hospital case fatality to variations in myocardial infarction mortality in 326 districts in England: spatial analysis of linked hospitalisation and mortality data
T2  - The Lancet Public Health
UR  - http://dx.doi.org/10.1016/S2468-2667(22)00108-6
UR  - http://hdl.handle.net/10044/1/96945
VL  - 7
ER  -
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