ORIGINAL ARTICLENeighborhood Income and Individual Education: Effect on Survival After Myocardial Infarction
Section snippets
PATIENTS AND METHODS
The study was conducted in Olmsted County, MN, where Mayo Clinic and the Olmsted Medical Center provide medical care for all county residents. Each institution uses a unit medical record in which the details of care for a patient, regardless of setting, are available in one place. The records are easily retrievable because Mayo Clinic maintains extensive indices that, through the Rochester Epidemiology Project, are extended to the records of other health care providers in the county, linking
RESULTS
The baseline characteristics across income tertiles and education categories are presented in Table 2. On average, patients living in less affluent areas were older and more likely to be female and of races other than white. They also presented with more comorbidity and included a higher proportion of smokers than their more affluent counterparts. No other differences were observed after adjustment for age and sex. The percentages of patients with fewer than, equal to, and greater than 12 years
DISCUSSION
Measures of SES are well-established determinants of overall health, quality of life, and life expectancy.33, 34 However, because SES is a complex multidimensional construct, the mechanisms by which it affects health are still incompletely understood. Although SES has traditionally been treated as an intrinsic characteristic of individuals, contextual effects of SES on health are theoretically important. Indeed, growing evidence suggests that a person's health can be influenced by the
CONCLUSION
In this community-based cohort of MI, low neighborhood income and lower levels of individual education were associated with a worse clinical presentation. Further, both measures showed a dose-response relationship with mortality. The association between low neighborhood income and increased mortality risk persisted even after controlling for a variety of potential confounders. These findings indicate the importance of SES in determining prognosis after MI.
Acknowledgments
We are indebted to Ellen E. Koepsell, RN, and Susan Stotz, RN, for valuable assistance in study coordination and data collection.
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This study was funded by grants from the Public Health Service and the National Institutes of Health (AR30582, R01 HL 59205, and R01 HL 72435). Dr Roger is an Established Investigator of the American Heart Association.
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Dr Jacobsen is now with Kaiser Permanente Southern California, Pasadena