Copyright © 2003 by the European Society of Cardiology.
Ethnic differences in acute myocardial infarction in Singapore
a Department of Cardiology, National Heart Centre, Singapore
b Department of Community, Family and Occupational Medicine, National University of Singapore, Singapore
c Department of Social Medicine, Hadassah Medical Organization and Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
d Division of Epidemiology and Disease Control, Ministry of Health, Singapore
Received May 13, 2002; accepted June 12, 2002 * Correspondence: Koon-Hou Mak, MBBS, FESC, Department of Cardiology, National Heart Centre, 17 Third Hospital Avenue, Singapore 168752
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.
Key Words: Case-fatality • coronary • gender • incidence • mortality • race
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