Objective: To study how income and educational level influence mortality after acute myocardial infarction (AMI).
Design and setting: Prospective analysis using individual level linkage of registries in Denmark.
Participants: All patients 30–74 years old hospitalised for the first time with AMI in Denmark in 1995–2002.
Main outcome measures: Relative risk (RR) of 30 day mortality and long term mortality (31 days until 31 December 2003) associated with income (adjusted for education) or educational level (adjusted for income) and further adjusted for sex, age, civil status, and comorbidity.
Results: The study identified 21 391 patients 30–64 years old and 16 169 patients 65–74 years old. The 30 day mortality was 7.0% among patients 30–64 years old and 15.9% among those 65–74 years old. Among patients surviving the first 30 days, the long term mortality was 9.9% and 28.3%, respectively. The adjusted RR of 30 day mortality and long term mortality among younger patients with low compared with high income was 1.54 (95% confidence interval 1.36 to 1.79) and 1.65 (1.45 to 1.85), respectively. The RR of 30 day and long term mortality among younger patients with low compared with high education was 1.24 (1.03 to 1.50) and 1.33 (1.11 to 1.59), respectively. The RR of 30 day and long term mortality among older patients with low compared with high income was 1.27 (1.15 to 1.41) and 1.38 (1.27 to 1.50), respectively. Older high and low education patients did not differ in mortality.
Conclusion: This study shows that both educational level and income substantially and independently affect mortality after AMI, indicating that each indicator has specific effects on mortality and that these indicators are not interchangeable.
- AMI, acute myocardial infarction
- SES, socioeconomic status
- acute myocardial infarction
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JNR was responsible for designing the study, analysing and interpreting data, drafting the manuscript, and acts as guarantor. SR was responsible for collecting data, analysing and interpreting data, and critically revising the manuscript. SZA was responsible for collecting data, interpreting data, and critically revising the manuscript. GG, Pernille Buch, Lars Køber, and Christian Torp-Pedersen were responsible for interpreting data and critically revising the manuscript. FD, MO, and MM were responsible for conceiving of and designing the study, interpreting data, critically revising the manuscript, and supervising.
Funding: the study was supported by the Danish Heart Foundation, grant no: 04-4-9-B19-A14-22132 and by Denmark’s Ministry of Interior and Health. The funding sources had no involvement in the manuscript.
Competing interests: none declared.
Ethical approval: the project did not require approval by the regional committee on biomedical research ethics