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Regional variation in incidence and case fatality of myocardial infarction among young women in England, Scotland and Wales

OBJECTIVES To examine the regional variation in incidence and case fatality of myocardial infarction among young women. DESIGN Cross sectional survey, using population based incidence data. SETTING England, Scotland and Wales. SUBJECTS Subjects were women aged 16–44 with a diagnosis of myocardial infarction between 1 October 1993 and 15 October 1995. OUTCOME MEASURES Incidence of myocardial infarction per 100 000 women years, with case fatality as a percentage of total cases. RESULTS Incidence of myocardial infarction rose steeply from age 33 upwards, (maximum = 20.2 cases per 100 000 women years at age 44). The adjusted incidence rate for myocardial infarction was 3.7 (95% CI 3.2, 4.2) times greater in Scotland than in southern England. In contrast, case fatality was significantly lower in Scotland: 18.5% (95% CI 13.1%, 25.0%), compared with 31.0% (95% CI 25.9%, 36.0%) in southern England. CONCLUSIONS The incidence of myocardial infarction varied widely within the United Kingdom. Case fatality variation may reflect differences in ambulance response, or in diagnostic acumen, within the regions.