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Lower education level linked with higher rates of STEMI-related mortality

Mehta R. J Am Coll Cardiol. 2011;57:138-146.

Issue: February 2011

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Researchers have reported an inverse relationship between years of education and 1-year mortality in patients treated for STEMI.

In the study, data from 11,326 patients with STEMI who received fibrinolysis from the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III) trial, which was conducted from Oct. 1995 to Jan. 1997, were analyzed. Researchers examined unadjusted in-hospital clinical outcomes and in-hospital, 30-day and 1-year mortality, as well as adjusted 1-year mortality.

They found an inverse association between 1-year mortality and years of education, culminating with a fivefold increase in the mortality rate seen in patients with less than 8 years vs. those with more than 16 years of education (17.5% vs. 3.5%; P<.0001). Although the strength of this relationship varied among different countries, years of education still remained an independent factor of mortality between day 8 and 1 year, with an HR of 0.96 per year of increase in education (95% CI, 0.94-0.98).

In addition, aside from in-hospital bleeding, most in-hospital adverse outcomes, including mortality and reinfarction, were also inversely related to education level.

“This study demonstrates that lower socioeconomic status, as ascertained by years of completed education, was associated with significantly poorer outcomes in subjects who received fibrinolysis after hospitalization for acute STEMI,” the researchers wrote. “Although fewer years of education were associated with adverse demographic, clinical and presenting features that have been shown to portend a poor prognosis in STEMI patients, years of education remained independently correlated with mortality, even after accounting for these high-risk characteristics.”

They said future studies should investigate the behavioral, social, biological and physiological mechanisms that underlie the link between socioeconomic status and CVD outcomes.

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