Increasing myocardial infarction mortality trends in a middle-income country.

Background: Developed countries continue to show a decrease in cardiovascular disease (CVD) mortality. Little is known about CVD mortality trends in low and middle-income countries. The aim of our study is to describe myocardial infarction (MI) mortality trends and evaluate if differences between ethnic groups and geographic regions are present among the Ecuadorians with acute MI.

Methods: We conducted a cross sectional analysis mortality national registry and included deaths related to MI between 2012 and 2016 that had complete demographic data. To describe the general population, we used the 2010 census and applied estimates as population projections. We calculated age and sex standardized MI mortality rates per 100,000. We compared trends in MI mortality rate for every ethnic group and geographic region and used linear regression to estimate predictors of the changing mortality rates.

Results: We included 18,277 MI deaths between the years 2012 and 2016. The mean age of death was 73.6±19.5, 59% were male and 33% were illiterate. From 2012 to 2016, the standardized MI mortality rate increased from 51 to 157 deaths per 100,000. The most significant predictors of the increasing mortality rate were living in the coast (β=0.10), belonging to a mixed race (β=-0.033) and the year of death (β=0.013).

Conclusions: Our study found a worrisome increase in MI mortality between 2012-2016 in Ecuador, a middle-income country in South America. This rapid increase seems to be driven by geographic and racial differences. A thorough evaluation of the causes of this increase has to be undertaken by the Ecuadorian health authorities.