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Epidemiology
Explaining trends in coronary heart disease hospitalisations in New Zealand: trend for admissions and incidence can be in opposite directions
  1. W C Chan1,
  2. C Wright2,
  3. M Tobias2,
  4. S Mann3,
  5. R Jackson1
  1. 1
    Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
  2. 2
    Public Health Intelligence, Ministry of Health, Wellington, New Zealand
  3. 3
    Department of Medicine, University of Otago, Wellington, New Zealand
  1. Professor R Jackson, Section of Epidemiology and Biostatistics, School of Population Health, Tamaki Campus, Faculty of Medical and Health Sciences, University of Auckland, 100 Morrin Rd, Glen Innes, Private Bag 92019, Auckland, New Zealand; rt.jackson{at}auckland.ac.nz

Abstract

Background: A recent increase in the absolute number of hospitalisations for acute myocardial infarction (AMI) in New Zealand may signal a new epidemic of coronary heart disease (CHD).

Objective: To quantify the impact of factors other than incidence of disease on these national hospitalisation trends.

Methods: A total of 324 663 electronic records of New Zealand public CHD hospitalisations from 1993 to 2005 were examined. Repeat admissions were identified by record linkage using a unique national health identifier for each patient.

Results: Hospitalisations for AMI increased by about 8% a year throughout the 13-year study period. Interhospital transfers increased by 117% over the study period, while readmissions increased by 42%. By 2005 over 60% of all admissions for CHD were readmissions. After accounting for readmissions, hospital transfers and population changes, the age-standardised first AMI hospitalisation rate peaked in 1995 and has since declined by 15%. Reciprocal trends in AMI and angina hospitalisations were seen, indicating changing diagnostic criteria. Overall hospitalisation rates for first CHD events remained relatively steady at about 216.4 events per 100 000 between 1993 and 2000 and subsequently declined by 25% to 162.2 events per 100 000 in 2005.

Conclusion: Recent trends in hospitalisation rates for AMI are significantly influenced by factors other than underlying changes in CHD incidence. Increasing absolute numbers of admissions coded as AMI in New Zealand between 1993 and 2005 can be accounted for by increases in readmissions, increases in interhospital transfers, changes in diagnostic criteria for AMI and in demography.

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Footnotes

  • Funding: WCC’s masters research was funded by a study grant from New Zealand Population Health charitable Trust.

  • Competing interests: This article is part of the dissertation for a Master of Public Health undertaken in University of Auckland by WCC. CW is a senior advisor (statistics and epidemiology) working for the Ministry of Health, New Zealand. MT is a public health physician working for the Ministry of Health, New Zealand. SM and RJ have no conflict of interest.

  • Opinions in the paper are those of the authors and do not necessarily reflect Ministry of Health policy advice.

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