Purpose We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin and medical treatment were mediated by socioeconomic status (SES). Methods This register-based follow-up study consisted of individuals >17 years of age, admitted to hospital with AMI between 2001 and 2005 (n=25 443). Danish-born residents were compared with immigrants from Turkey, Pakistan and Yugoslavia. Individuals were identified by civil registration number, and data were obtained through linkage to the national registers of hospitalisations and drug prescriptions. Odds of initiating treatment and hazard ratios (HR) of terminating treatment were estimated. Mediators such as income and employment were included in the models. Results Pakistanis were less likely than Danish-born residents to initiate treatment with beta-blockers after AMI [odds ratio 0.52; 95% confidence interval (CI) 0.34-0.80]. Immigrants from Turkey (HR 1.36; 95% CI 1.07-1.73) and Pakistan (HR 1.59; 95% CI 1.21-2.08) were more likely to terminate treatment with beta-blockers before being recommended to do so. Estimates did not change markedly when income and education were included in the models. Conclusions The results of this study suggest that immigrants from Pakistan and Turkey do not receive adequate medical treatment with beta-blockers after a first AMI compared with Danish-born residents. Mediators such as income and employment may not be sufficient indicators of SES when the effect of patient origin on medical treatment is explored. A lower SES of immigrants, communication problems between doctor and patient and doctors' attitudes towards immigrants may explain ethnic differences in medical treatment after AMI.

Socioeconomic status immigrants Acute myocardial infarction Statins Beta-blockers

education hospital admission Pakistan doctor patient relation immigrant hospitalization Myocardial Infarction Adrenergic beta-Antagonists Hydroxymethylglutaryl-CoA Reductase Inhibitors beta adrenergic receptor blocking agent Follow-Up Studies register follow up human middle aged Denmark controlled study Turkey (republic) priority journal acute disease comparative study Yugoslavia medication compliance ethnology prescription income social status migrant ethnic difference Humans Adolescent male Emigrants and Immigrants female Article hydroxymethylglutaryl coenzyme A reductase inhibitor physician attitude adult major clinical study Turkey age distribution Models, Statistical acute heart infarction statistical model social class employment Medication Adherence