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People
with lower incomes, lower education levels
have higher death rates after experiencing
Heart Attack
Newswise — Researchers have
long suspected that socioeconomic factors
like education level and income also might
affect survival rates following heart
attack.
In the June issue of Mayo
Clinic Proceedings, Mayo Clinic researchers
present new data suggesting that people with
lower incomes and education levels are more
likely to die after heart attack than more
affluent, educated people.
Over the past several
decades, medical research has helped
identify a list of factors that increase a
person’s risk for myocardial infarction, the
disruption of blood flow to the heart
commonly known as heart attack.
These factors include
behaviors such as smoking or inactivity, and
a variety of physical characteristics,
including high blood pressure, high blood
cholesterol and obesity.
Today, better awareness of
heart attack signs and symptoms and improved
treatments help many survive that first
heart attack.
Mayo authors examined medical
records from 705 patients residing in
Olmsted County, Minn. -- the location of
Mayo Clinic -- who were treated for heart
attack between Nov. 1, 2002 and May 31,
2006.
Researchers recorded the
years of schooling completed (self-reported
by the patients via a questionnaire) and
neighborhood income (obtained by linking the
participant address to the 2000 U.S. Census
Bureau data) for each participant.
Participants were divided into three income
groups and three education groups.
Researchers analyzed survival data across
these different groups.
Among the 155 deaths recorded
during the study period, one-year survival
estimates across income groups were lowest
for people with the lowest income.
Seventy-five percent were
survivors among people earning $28,732 to
$44,665; 83 percent survived among people
earning $49,435 to $53,561; and 86 percent
survived among people earning $56,992 to
$74,034. Similarly, the survival rates were
lowest for participants with less education.
Sixty-seven percent were
survivors among those who had fewer than 12
years of education; 81 percent survived
among people with 12 years of education; and
85 percent survived among people with
greater than 12 years of education.
The authors say that while
many previous studies have sought to link
socioeconomic status and poor outcomes
following heart attack, this study design
has yielded some unique results.
“Interestingly, despite the
higher-than-average socioeconomic status of
this population, the associations of
individual education and neighborhood income
with death after heart attack were stronger
than those reported in many previous
studies,” notes Mayo Clinic cardiovascular
researcher Yariv Gerber, Ph.D., the study’s
lead author.
“We think our approach of
evaluating two different and complementary
indicators of socioeconomic status allowed
us to capture a wider spectrum of this
complex theory.”
Mayo researchers believe that
the association observed for education could
be related to education’s positive effect on
factors that include job opportunities,
income, housing, access to nutritious foods
and health insurance.
“Higher levels of education
also could directly affect health through
greater knowledge acquired during schooling
and greater empowerment and self-efficacy,”
writes Dr. Gerber.
“As recently reported,
education is strongly associated with health
literacy, which in turn affects one’s
ability to obtain, process, and understand
basic health information and services needed
to make appropriate health decisions.”
Mayo researchers also point
out that more specific mechanisms linking
low socioeconomic status to survival
following heart attack could also be related
to the greater difficulty that poorer
individuals with lower education levels have
in attending cardiac rehabilitation programs
and adhering to medications and lifestyle
recommendations.
A peer-review journal, Mayo
Clinic Proceedings publishes original
articles and reviews dealing with clinical
and laboratory medicine, clinical research,
basic science research and clinical
epidemiology.
Mayo Clinic Proceedings is
published monthly by Mayo Foundation for
Medical Education and Research as part of
its commitment to the medical education of
physicians.
The journal has been
published for more than 80 years and has a
circulation of 130,000 nationally and
internationally. Articles are available
online at
http://www.mayoclinicproceedings.com
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