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Education and risk for acute myocardial infarction in 52 high, middle and low-income countries: INTERHEART case-control study

Rosengren, Annika, 1951 (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin,Institute of Medicine, Department of Emergeny and Cardiovascular Medicine
Subramanian, S. V. (author)
Islam, S. (author)
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Chow, C. K. (author)
Avezum, A. (author)
Kazmi, K. (author)
Sliwa, K. (author)
Zubaid, M. (author)
Rangarajan, S. (author)
Yusuf, S. (author)
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 (creator_code:org_t)
2009
2009
English.
In: Heart. - 1468-201X. ; 95:24, s. 2014-22
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • OBJECTIVE: To determine the effect of education and other measures of socioeconomic status (SES) on risk of acute myocardial infarction (AMI) in patients and controls from countries with diverse economic circumstances (high, middle, and low income countries). DESIGN: Case-control study. SETTING: 52 countries from all inhabited regions of the world. PARTICIPANTS: 12242 cases and 14622 controls. MAIN OUTCOME MEASURES: First non-fatal AMI. RESULTS: SES was measured using education, family income, possessions in the household and occupation. Low levels of education (< or =8 years) were more common in cases compared to controls (45.0% and 38.1%; p<0.0001). The odds ratio (OR) for low education adjusted for age, sex and region was 1.56 (95% confidence interval 1.47 to 1.66). After further adjustment for psychosocial, lifestyle, other factors and mutually for other socioeconomic factors, the OR associated with education < or =8 years was 1.31 (1.20 to 1.44) (p<0.0001). Modifiable lifestyle factors (smoking, exercise, consumption of vegetables and fruits, alcohol and abdominal obesity) explained about half of the socioeconomic gradient. Family income, numbers of possessions and non-professional occupation were only weakly or not at all independently related to AMI. In high-income countries (World Bank Classification), the risk factor adjusted OR associated with low education was 1.61 (1.33 to 1.94), whereas it was substantially lower in low-income and middle-income countries: 1.25 (1.14 to 1.37) (p for interaction 0.045). CONCLUSION: Of the SES measures we studied, low education was the marker most consistently associated with increased risk for AMI globally, most markedly in high-income countries.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

Aged
Case-Control Studies
Educational Status
Female
Humans
Income/*statistics & numerical data
Life Style
Male
Middle Aged
Myocardial Infarction/*epidemiology/etiology
Odds Ratio
Risk Factors
Sex Distribution

Publication and Content Type

ref (subject category)
art (subject category)

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