title: Relationship of socioeconomic status to the incidence and prehospital, 28-day, and 1-year mortality rates of acute coronary events in the FINMONICA myocardial infarction register study.
abstract: BACKGROUND
  Low socioeconomic status (SES) is associated with increased coronary heart disease mortality rates. There are, however, very little data on the relation of SES to the incidence, recurrence, and prognosis of myocardial infarction (MI) events.
  
  
  RESULTS
  The FINMONICA MI Register recorded detailed information on all MI events among men and women aged 35 to 64 years in 3 areas of Finland during the period of 1983 to 1992. We carried out a record linkage of the MI register data with files of Statistics Finland to obtain information on indicators of SES, such as taxable income and education, for each individual who is registered. In the analyses, income was grouped into 3 categories (low, middle, and high), and education was grouped into 2 categories (basic and secondary or higher). Among men with their first MI event (n=6485), the adjusted incidence rate ratios were 1.67 (95% CI 1.57 to 1.78) and 1.84 (95% CI 1.73 to 1.95) in the low- and middle-income categories compared with the high-income category. For 28-day mortality rates, the corresponding rate ratios were 3.18 (95% CI 2.82 to 3.58) and 2.33 (95% CI 2.03 to 2.68). Significant differentials were observed for prehospital mortality rates, and they remained similar up to 1 year after the MI. Findings among the women were consistent with those among the men.
  
  
  CONCLUSIONS
  The excess coronary heart disease mortality and morbidity rates among persons with low SES are considerable in Finland. To bring the mortality rates of low- and middle-SES groups down to the level of that of the high-SES group constitutes a major public health challenge.
authors.affiliation: KTL-National Public Health Institute, Helsinki, Finland. veikko.salomaa@ktl.fi
authors.forename: V
authors.initials: V
authors.lastname: Salomaa
authors.forename: M
authors.initials: M
authors.lastname: Niemelä
authors.forename: H
authors.initials: H
authors.lastname: Miettinen
authors.forename: M
authors.initials: M
authors.lastname: Ketonen
authors.forename: P
authors.initials: P
authors.lastname: Immonen-Räihä
authors.forename: S
authors.initials: S
authors.lastname: Koskinen
authors.forename: M
authors.initials: M
authors.lastname: Mähönen
authors.forename: S
authors.initials: S
authors.lastname: Lehto
authors.forename: T
authors.initials: T
authors.lastname: Vuorenmaa
authors.forename: P
authors.initials: P
authors.lastname: Palomäki
authors.forename: H
authors.initials: H
authors.lastname: Mustaniemi
authors.forename: E
authors.initials: E
authors.lastname: Kaarsalo
authors.forename: M
authors.initials: M
authors.lastname: Arstila
authors.forename: J
authors.initials: J
authors.lastname: Torppa
authors.forename: K
authors.initials: K
authors.lastname: Kuulasmaa
authors.forename: P
authors.initials: P
authors.lastname: Puska
authors.forename: K
authors.initials: K
authors.lastname: Pyörälä
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000401:mortality*; D004522:Educational Status; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D012042:Registries; D017678:Sex Distribution; D012923:Social Class