title: Socioeconomic status and risk of acute myocardial infarction. Population-based case-control study.
abstract: OBJECTIVE
  Socioeconomic status is associated with cardiovascular mortality. The aims of this study were to investigate the association between socioeconomic status and its various indicators and the risk of acute myocardial infarction (AMI), and to determine whether any association found is independent of the presence of cardiovascular risk factors (CVRFs).
  
  
  METHODS
  Study cases were matched with controls by age, sex and year of recruitment. Cases were recruited from a hospital register and controls from cross-sectional studies of the general population. The socioeconomic status was determined from educational level and social class, as indicated by occupation. Self-reported data were collected on the presence of CVRFs.
  
  
  RESULTS
  The study included 1369 cases and controls. Both educational level and social class influenced AMI risk. Among non-manual workers, there was an inverse linear relationship between educational level and AMI risk independent of CVRFs: compared with university educated individuals, the odds ratio (OR) for an AMI among those with a high school education was 1.63 (95% confidence interval [CI], 1.16-2.3), and among those with an elementary school education, 3.88 (95% CI, 2.79-5.39). No association between educational level and AMI risk was observed in manual workers. However, the AMI risk was higher in manual workers than non-manual university educated workers: in those with an elementary school education, the increased risk (OR=2.09; 95% CI, 1.59-2.75) was independent of CVRFs.
  
  
  CONCLUSIONS
  An association was found between socioeconomic status and AMI risk. The AMI risk was greatest in individuals with only an elementary school education, irrespective of CVRFs and social class, as indicated by occupation.
authors.affiliation: Grupo de Epidemiología y Genética Cardiovascular, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Instituto Municipal de Investigación Médica (IMIM-Hospital del Mar), Barcelona, España.
authors.forename: Griselda
authors.initials: G
authors.lastname: González-Zobl
authors.forename: María
authors.initials: M
authors.lastname: Grau
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Muñoz
authors.forename: Ruth
authors.initials: R
authors.lastname: Martí
authors.forename: Héctor
authors.initials: H
authors.lastname: Sanz
authors.forename: Joan
authors.initials: J
authors.lastname: Sala
authors.forename: Rafael
authors.initials: R
authors.lastname: Masiá
authors.forename: Izabella
authors.initials: I
authors.lastname: Rohlfs
authors.forename: Rafel
authors.initials: R
authors.lastname: Ramos
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012307:Risk Factors; D012959:Socioeconomic Factors