J Epidemiol Community Health 65:301-309 doi:10.1136/jech.2009.104075
  • Evidence-based public health policy and practice

Socioeconomic position and incidence of acute myocardial infarction: a meta-analysis

  1. Tahereh Moradi2
  1. 1Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
  3. 3St Petersburg State Medical Academy named after II. Mechnicov, Division of Epidemiology, St Petersburg, Russia
  4. 4Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Anna Sidorchuk, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Karolinska Hospital, SE-171 76 Stockholm, Sweden; anna.sidorchuk{at}
  1. Contributors EM-G and AS contributed equally to the present work by conducting a systematic literature search, identifying the studies relevant for inclusion, extracting data for meta-analysis as well as by interpreting data and drafting and revising the article. AS also conducted the meta-analysis and participated in data quality assurance and control. JH helped identify the references relevant for inclusion and interpret the results. He participated in reviewing and revising the article. TM supervised the study activities and conceptualised the design and the study's analytic strategy. She also directed analysis and interpretation of data, including quality assurance and control, and reviewed the manuscript and participated in revising and finalising the article. All authors have read the manuscript and approved the final version submitted.

  • Accepted 12 June 2010
  • Published Online First 14 September 2010


Background A negative socioeconomic gradient is established for coronary heart disease (CHD) mortality and survival, while socioeconomic patterning of disease incidence is less well investigated. To study socioeconomic inequalities in the incidence of acute myocardial infarction (AMI), the major component of CHD, a meta-analysis was undertaken to summarise existing evidence on the issue.

Methods A systematic search was performed in PubMed and EMBASE databases for observational studies on AMI incidence and socioeconomic position (SEP), published in English to April 2009. A random-effects model was used to pool the risks estimates from the individual studies.

Results Among 1181 references, 70 studies fulfilled the inclusion criteria. An overall increased risk of AMI among the lowest SEP was found for all three indicators: income (pooled RR 1.71, 95% CI 1.43 to 2.05), occupation (pooled RR 1.35, 95% CI 1.19 to 1.53) and education (pooled RR 1.34, 95% CI 1.22 to 1.47). The strongest associations were seen in high-income countries such as USA/Canada and Europe, while the results were inconsistent for middle and low-income regions.

Conclusion AMI incidence is associated with low SEP. The nature of social stratification at the level of economic development of a country could be involved in the differences of risk of AMI between social groups.


  • EM-G and AS contributed equally.

  • Funding This work was supported by a grant from the Swedish Council for Working Life and Social Research (FAS 2006-0230 to TM), Stockholm, Sweden.

  • Competing of interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.