Own education, current conditions, parental material circumstances, and risk of myocardial infarction in a former communist country
- aInternational Centre for Health and Society, Department of Epidemiology and Public Health, University College London, London, bDepartment of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada, cDepartment of Preventive Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
- Dr M Bobak, International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT
- Accepted 4 July 1999
OBJECTIVE To study the association between own education, adult and parental circumstances and the risk of myocardial infarction in a former communist country.
DESIGN Population based case-control study.
SETTING General population of five districts of the Czech Republic in the age group 25–64 years.
PARTICIPANTS Random sample of population (938 men and 1048 women, response rate 77%) served as controls to 282 male and 80 female cases of non-fatal first myocardial infarctions.
MAIN OUTCOME MEASURES Myocardial infarction was defined by the WHO MONICA criteria based on ECG, enzymes and symptoms. The following socioeconomic indicators were studied: own education, crowded housing conditions (more than one person per room), car ownership, and education and occupation of mother and father.
RESULTS There was a weak correlation between education and car ownership, and a strong association between own education and parental education and occupation. Crowding was not related to other socioeconomic factors. The risk of myocardial infarction was inversely related to education, and was unrelated to material conditions and parental education and occupation. The age-sex-district adjusted odds ratios for apprenticeship, secondary, and university education, compared with primary education, were 0.87, 0.74 and 0.46, respectively (p for trend 0.009); odds ratios for car ownership and crowding were 1.01 (95% confidence intervals 0.77, 1.34) and 0.92 (0.76, 1.12), respectively. Further adjustment for parental circumstances and adult height did not change these estimates but adjustment for coronary risk factors reduced the gradient. Increased height seemed, anomalously, to confer a small increased risk.
CONCLUSIONS In this population, the social gradient in non-fatal myocardial infarction is only apparent for own education. Materialist explanations for this gradient seem unlikely but behaviours seem responsible for a part of the gradient.
Funding: the Czech MONICA study was funded by the Czech Ministry of Health. The case-control extension of the study was funded by a grant from the Wellcome Trust. MB was supported by the Wellcome Trust Research Training Fellowship in Clinical Epidemiology. CH has been supported by the Canadian Institute for Advanced Research, and MM is recipient of the British Medical Research Council Professorship.
Conflicts of interests: none.