In-and out-of-hospital deaths by acute myocardial infarction in brazilian state capitals

Abstract

Background: Acute myocardial infarction (AMI) is the main cause of death in Brazil and the world. Approximately half of these deaths occur outside the hospital. Objectives: To analyze the distribution, temporal evolution, and sociodemographic characteristics (SDC) of in-and out-of-hospital deaths by AMI in Brazilian state capitals and their relationship with municipal development indicators (MDI). Methods: This is an ecological study of the number of deaths due to AMI reported annually by the 27 Brazilian state capitals from 2007 to 2016; these were divided into 2 groups: in-hospital (H) and out-of-hospital (OH). We evaluated the temporal evolution of mortality rates in each group and differences in SDC. Negative binomial regression models were used to compare the temporal evolution of the number of deaths in each group with the following variables: residing in the South/Southeast regions (S/SE), municipal human development index (MHDI), Gini coefficient, and expected years of schooling (EYS). We considered p-values < 0.05 as statistically significant. Results: The OH mortality rate increased with time for all state capitals. All studied SDC were different between groups (p < 0.001). In the OH group, most deaths were of men and patients aged 80 years or older and not married. S/SE increased the incidence of OH deaths (incidence rate ratio [IRR] = 2.84; 95% confidence interval [CI] = 1.67–4.85), while higher EYS reduced it (IRR = 0.86; 95% CI = 0.77–0.97). In the H group, higher MHDI reduced the incidence of deaths (IRR = 0.44; 95% CI = 0.33–0.58), while higher EYS increased it (IRR = 1.09; 95% CI = 1.03–1.15). Conclusions: In-and out-of-hospital deaths due to AMI in Brazilian state capitals were influenced by MDI, presented sociodemographic differences and a progressive increase in out-of-hospital occurrences.