ArticleBMJ open2015
A multilevel analysis of mortality following acute myocardial infarction in Norway: do municipal health services make a difference?
Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Article
- Hospital Variation in 30-Day Mortality for Patients With Stroke; The Impact of Individual and Municipal Socio-Demographic Status.Journal of the American Heart Association · 2019Article
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Authors and funding
2 authors.
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Abstract
objectivesStudies link area features such as neighbourhood socioeconomic deprivation to poor health outcomes. However, there is a paucity of research based on representative data investigating the effects of area-level health services on mortality. This study examines the extent to which municipal health services account for municipal variation in all-cause and cardiovascular disease (CVD) mortality. We hypothesise that unfavourable municipal features (eg, fewer available places for rehabilitation) are associated with higher risk of mortality after accounting for patients' characteristics.
designPopulation data from Norwegian national/municipal registrars are analysed using multilevel logistic regression in this prospective cohort study. SETTING AND
participantsThe analytic sample (9412 patients aged 18+ from 336 municipalities) constitutes 87.7% of the nationwide population of Norwegian adults who were hospitalised for acute myocardial infarction (AMI) in 2009 and discharged alive. PRIMARY OUTCOME MEASURES: All-cause and CVD mortality occurring within 365 days after the first day of hospitalisation for AMI.
resultsThere was a small but significant variation at the municipal level in all-cause mortality (0.5%; intraclass correlation coefficient=0.005) but not CVD mortality. There were no significant fixed effects of municipal health services on mortality in bivariate models. Patients' characteristics (eg, gender, comorbidities) fully accounted for the observed municipal variation in mortality. Being male versus female (OR=1.21, 95% CI 1.02 to 1.43), or having been previously diagnosed with dementia versus not (OR=2.06, 95% CI 1.53 to 2.77) were also linked to higher odds of death.
conclusionsMunicipal variation in all-cause mortality for Norwegian patients with AMI appears to be driven not by differences across municipalities in health service levels, but by differences across municipalities in the composition of patients. Focusing on chronic disease prevention and treatment, and tackling personal and structural risk factors embedded within patients' sociodemographic characteristics, may be especially beneficial for longevity.
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