Analysing variation by ethnic group in incidence and case-fatality of myocardial infarction in England
Myocardial infarction (MI) is one of the leading causes of death in the UK and globally. Previous work has shown that age-standardised mortality rates from MI declined by about half between 2002 and 2010 in the UK. Half of this decline was due to a fall in incidence and half due to improved case-fatality rates1. This work provided important information about the incidence and case fatality of MI in the general population, but we do not know how much this varies by ethnicity or socioeconomic status.
Higher levels of mortality from cardiovascular diseases are well documented in some ethnic groups and those in lower socioeconomic groups. However, very little is understood about how incidence and case-fatality varies by these characteristics. Understanding inequalities in incidence is key to developing appropriate prevention strategies, but currently England-level information on this is lacking. Qualitative research has explored attitudes to risk factors for MI, but the combined effect of material deprivation and cultural values has rarely been explored. This knowledge is vital to develop evidence-based policies to combat the determinants of ethnic, social and material inequalities in incidence and case-fatality from MI, and other cardiovascular conditions.
The aim of this project is to understand the nature of and reasons behind variation in MI incidence between ethnic and socioeconomic groups in England.
This DPhil will analyse Hospital Episode Statistics linked to mortality data for the whole of England. Hospital episode statistics in England cover the entire English population that have been admitted to hospital. When linked to mortality data, incidence and case-fatality estimates can be obtained by ethnicity and deprivation. There will then be an option to explore the findings from this analysis in depth using focus groups and semi-structured interviews. This will provide valuable evidence on the mechanisms behind inequalities in MI.
- K Smolina, L Wright, M Rayner, M J Goldacre. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study. BMJ 2012;344:d8059
Research Experience, Research Methods and Training
This DPhil project will develop experience of:
- Systematic reviews
- Managing large datasets
- Statistical techniques
- Qualitative research
- Mixed-methods research
Field Work, Secondments, Industry Placements and Training
DPhil candidates will be able to attend relevant training courses and will learn how to present their findings at research meetings. The qualitative research would involve some fieldwork within England.
The candidate should have some existing knowledge of statistics and have a genuine interest in health inequalities and cardiovascular disease epidemiology.