American Journal of Epidemiology Advance Access first published online on May 8, 2008
This version published online on June 25, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn107
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Practice of Epidemiology |
Impact of New Biomarkers of Myocardial Damage on Trends in Myocardial Infarction Hospital Admission Rates from Population-based Administrative Data
1 School of Population Health, University of Western Australia, Crawley, Western Australia, Australia
2 School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Nedlands, Western Australia, Australia
Correspondence to Dr. Frank Sanfilippo, School of Population Health M431, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia (e-mail: frank.sanfilippo{at}uwa.edu.au).
Received for publication August 7, 2007. Accepted for publication March 31, 2008.
Use of troponin testing in the diagnosis of myocardial infarction substantially increases the number of cases diagnosed as myocardial infarction among suspected cases in comparison with previous criteria. However, the impact of troponin testing on rates reported in national statistics that use routinely collected hospital morbidity data is uncertain. The authors developed Poisson regression models to estimate the effect of troponin testing on long-term trends in hospital admission rates in Perth, Western Australia, from 1980 to 2004. Troponin tests were used for 10.5% of patients with suspected myocardial infarction in 1996, rising rapidly to more than 90% of patients from 2001 onward. Fitted models that assumed a continuing linear decline estimated that 100% use of troponin testing in cases of suspected myocardial infarction would lead to an apparent increase in hospital admission rates of 42% (95% confidence interval (CI): 28, 56) in men and 21% (95% CI: 4, 41) in women as compared with rates that would be expected if previous linear trends had continued. Smaller effects of 30% (95% CI: 14, 48) in men and –2% (95% CI: –21, 20) in women were found in fitted models that assumed an underlying attenuating trend in the rates. Similarly constructed logistic regression trend models found no significant effect of troponin testing on trends in 28-day case-fatality.
coronary disease; diagnosis; medical record linkage; mortality; myocardial infarction; troponin
Abbreviations: ICD, International Classification of Diseases
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