title: Long-term survival among older patients with myocardial infarction differs by educational level: results from the MONICA/KORA myocardial infarction registry.
abstract: BACKGROUND
  Socioeconomic disparities in survival after acute myocardial infarction (AMI) have been found in many countries. However, population-based results from Germany are lacking so far. Thus, the objective of this study was to examine the association between educational status and long-term mortality in a population-based sample of people with AMI.
  
  
  METHODS
  The sample consisted of 2,575 men and 844 women, aged 28-74 years, hospitalized with a first-time AMI between 1 January 2000 and 31 December 2008, recruited from a population-based AMI registry. Patients were followed up until December 2011. Data on education, risk factors and co-morbidities were collected by individual interviews; data on clinical characteristics and AMI treatment by chart review. Cox proportional hazards models were used to assess the relationship between educational status and long-term mortality.
  
  
  RESULTS
  During follow-up, 19.1% of the patients with poor education died compared with 13.1% with higher education. After adjustment for covariates, no effect of education on mortality was found for the total sample and for patients aged below 65 years. In older people, however, low education level was significantly associated with increased mortality (hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.05-1.98, p = 0.023). Stratified analyses showed that women older than 64 years with poor education were significantly more likely to die than women in the same age group with higher education (HR 1.57, 95% CI 1.02-2.41, p = 0.039).
  
  
  CONCLUSIONS
  Elderly, poorly educated patients with AMI, and particularly women, have poorer long-term survival than their better educated peers. Further research is required to illuminate the reasons for this finding.
authors.affiliation: Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr, 2, Augsburg D-86156, Germany. Inge.Kirchberger@helmholtz-muenchen.de.
authors.forename: Inge
authors.initials: I
authors.lastname: Kirchberger
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Hildegard
authors.initials: H
authors.lastname: Golüke
authors.forename: Margit
authors.initials: M
authors.lastname: Heier
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kuch
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.forename: Philip A
authors.initials: PA
authors.lastname: Quinones
authors.forename: Wolfgang
authors.initials: W
authors.lastname: von Scheidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
mesh_terms: D000328:Adult; D000368:Aged; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D017741:Survivors; D013997:Time Factors