Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986-95: a retrospective cohort study

Background Most deaths from coronary heart disease occur out of hospital. Hospital patients face social, age, and sex inequalities. Our aim was to examine inequalities and trends in out-of-hospital cardiac deaths. Methods We used the Scottish record linked database to identify all deaths from acute myocardial infarction that occurred in Scotland (population 5.1 million), in 1986-95. We have compared population-based death rates for men and women across age and social groups. Findings Between 1986 and 1995, 83 365 people died from acute myocardial infarction, out of hospital and without previous hospital admission (44 655 men, 38 710 women); and 117 749 were admitted with a first acute myocardial infarction, of whom 37 020 died within 1 year. Thus, out-of-hospital deaths accounted for 69.2% (95% CI 69.0-69.5) of all 120 385 deaths. Out-of-hospital deaths, measured as a proportion of all acute myocardial infarction events (deaths plus first hospital admissions), increased with age, from 20.1% (19.2-21.0) in people younger than 55 years, to 62.1% (61.3-62.9) in those older than 85 years. Population-based out-of-hospital mortality rates fell by a third in men and by a quarter in women. Mean yearly falls were larger in people aged 55-64 years (5.6% per year in men, 3.7% in women), than in those older than 85 years (2.5% in men and women), Mortality rates were substantially higher in deprived socioeconomic groups than in affluent groups, especially in people younger than 65 years. Interpretation These inequalities in age, sex, and socioeconomic class should be actively addressed by prevention strategies for coronary heart disease.