Rosengren A, Subramanian S V, Islam S, Chow C K, Avezum A, Kazmi K, Sliwa K, Zubaid M, Rangarajan S, Yusuf S
Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Ostra, SE-416 85 Goteborg, Sweden.
Heart. 2009 Dec;95(24):2014-22. doi: 10.1136/hrt.2009.182436. Epub 2009 Oct 12.
To determine the effect of education and other measures of socioeconomic status (SES) on risk of acute myocardial infarction (AMI) in patients and controls from countries with diverse economic circumstances (high, middle, and low income countries).
Case-control study.
52 countries from all inhabited regions of the world.
12242 cases and 14622 controls.
First non-fatal AMI.
SES was measured using education, family income, possessions in the household and occupation. Low levels of education (< or =8 years) were more common in cases compared to controls (45.0% and 38.1%; p<0.0001). The odds ratio (OR) for low education adjusted for age, sex and region was 1.56 (95% confidence interval 1.47 to 1.66). After further adjustment for psychosocial, lifestyle, other factors and mutually for other socioeconomic factors, the OR associated with education < or =8 years was 1.31 (1.20 to 1.44) (p<0.0001). Modifiable lifestyle factors (smoking, exercise, consumption of vegetables and fruits, alcohol and abdominal obesity) explained about half of the socioeconomic gradient. Family income, numbers of possessions and non-professional occupation were only weakly or not at all independently related to AMI. In high-income countries (World Bank Classification), the risk factor adjusted OR associated with low education was 1.61 (1.33 to 1.94), whereas it was substantially lower in low-income and middle-income countries: 1.25 (1.14 to 1.37) (p for interaction 0.045).
Of the SES measures we studied, low education was the marker most consistently associated with increased risk for AMI globally, most markedly in high-income countries.
确定教育及其他社会经济地位（SES）指标对来自不同经济状况国家（高收入、中等收入和低收入国家）的患者及对照人群急性心肌梗死（AMI）风险的影响。
病例对照研究。
世界所有有人居住地区的52个国家。
12242例病例和14622名对照。
首次非致死性AMI。
采用教育程度、家庭收入、家庭财产及职业来衡量SES。与对照相比，病例中低教育水平（≤8年）更为常见（45.0%和38.1%；p<0.0001）。经年龄、性别和地区调整后，低教育水平的比值比（OR）为1.56（95%置信区间1.47至1.66）。在进一步对心理社会、生活方式、其他因素以及其他社会经济因素进行相互调整后，与≤8年教育相关的OR为1.31（1.20至1.44）（p<0.0001）。可改变的生活方式因素（吸烟、运动、蔬菜水果摄入、饮酒及腹型肥胖）解释了约一半的社会经济梯度。家庭收入、财产数量及非专业职业与AMI仅存在微弱关联或无独立关联。在高收入国家（世界银行分类），调整风险因素后的OR与低教育水平相关的为1.61（1.33至1.94）；而在低收入和中等收入国家则显著更低：1.25（1.14至1.37）（交互作用p值为0.045）。
在我们研究的SES指标中，低教育水平是全球范围内与AMI风险增加最始终相关的标志，在高收入国家最为明显。
