Time Trends and Educational Inequalities in Out-of-Hospital Coronary Deaths in Norway 1995-2009: A Cardiovascular Disease in Norway (CVDNOR) Project

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Enxhela Sulo, Ottar Nygård, Stein Emil Vollset, Jannicke Igland, Marta Ebbing, Truls Østbye, Torben Jørgensen, Gerhard Sulo, Grethe S. Tell

BACKGROUND: Recent time trends and educational gradients characterizing out-of-hospital coronary deaths (OHCD) are poorly described.

METHODS AND RESULTS: We identified all deaths from coronary heart disease occurring outside the hospital in Norway during 1995 to 2009. Time trends were explored using Poisson regression analysis with year as the independent, continuous variable. Information on the highest achieved education was obtained from The National Education Database and classified as primary (up to 10 years of compulsory education), secondary (high school or vocational school), or tertiary (college/university). Educational gradients in OHCD were explored using Poisson regression, stratified by sex and age (<70 and ≥70 years), and results were expressed as incidence rate ratios (IRRs) and 95%CIs. Of 100 783 coronary heart disease deaths, 58.8% were OHCDs. From 1995 to 2009, age-adjusted OHCD rates declined across all education categories (primary, secondary, and tertiary) in younger men (IRR=0.35; 95%CI 0.32-0.38; IRR=0.38; 95%CI 0.35-0.42; IRR=0.33; 95%CI 0.28-0.40), younger women (IRR=0.47; 95% CI 0.40-0.56; IRR=0.55; 95%CI 0.45-0.67; IRR=0.28; 95% CI 0.16-0.47), older men (IRR=0.20; 95%CI 0.19-0.22; IRR=0.20; 95%CI 0.18-0.22; IRR=0.20; 95%CI 0.17-0.23), and older women (IRR=0.26; 95%CI 0.24-0.28; IRR=0.25; 95%CI 0.23-0.28; IRR=0.28; 95%CI 0.22-0.34). Tertiary education was associated with lower risk of OHCD compared to primary education (IRR=0.37; 95%CI 0.35-0.40 in younger men, IRR=0.26; 95%CI 0.22-0.30 in younger women, IRR=0.52; 95%CI 0.49-0.55 in older men, and IRR=0.61; 95%CI 0.57-0.66 in older women). These gradients did not change over time (Pinteraction=0.25).

CONCLUSIONS: Although OHCD rates declined substantially during 1995 to 2009, they displayed educational gradients that remained constant over time.

Original languageEnglish
Article numbere005236
JournalJournal of the American Heart Association
Issue number2
Pages (from-to)1-11
Number of pages11
Publication statusPublished - 20 Feb 2017

    Research areas

  • Adult, Age Distribution, Aged, Aged, 80 and over, Cardiovascular Diseases/mortality, Cause of Death, Educational Status, Female, Forecasting, Humans, Incidence, Male, Middle Aged, Norway/epidemiology, Out-of-Hospital Cardiac Arrest/epidemiology, Registries, Retrospective Studies, Sex Distribution, Socioeconomic Factors, Survival Rate/trends, Time Factors

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