Constituent country inequalities in myocardial infarction incidence and case fatality in men and women in the United Kingdom, 1996–2005

Background: Understanding myocardial infarction (MI) incidence and case fatality trends across the four UK constituent countries is of importance following devolution of the government of health-care services. Methods: Retrospective cohort study using a primary care database (5.19 million patients) examining trends in incidence of first MI and 30-day case fatality. Results: From 1996 to 2005, the incidence of MI decreased in all countries, but reductions were greater in England (men, −3.1%; women, −2.8%) and Wales (men, −3.3%; women, −4.6%) than in Scotland (men, −1.9%; women, −0.6%) and Northern Ireland (men no change, women, −0.8%) (average annual percentage change). Greater reductions in England and Wales than Scotland and Northern Ireland meant a widening of north–south difference in MI incidence over the study period. Downward trends in 30-day case fatality were found in each country but less regional variation was evident (England men, −12.0%, women, −11.0%; Wales men, −18.4%, women, −12.6%; Scotland men, −9.5%, women, −9.0%; Northern Ireland men, −8.6%, women, −13.0%). Conclusion: From 1996 to 2005, downward trends in the incidence of first MI and 30-day case fatality were evident in each constituent country. Greater improvements in case fatality, compared with incidence, were found within each country.