title: Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran.
abstract: BACKGROUND
  Since no hospital-based, nationwide study has been yet conducted on the association between risk factors and in-hospital mortality due to myocardial infarction (MI) by educational level in Iran, the present study was conducted to investigate relationship between risk factors and in-hospital mortality due to MI by educational level.
  
  
  METHODS
  In this nationwide hospital-based, prospective analysis, follow-up duration was from definite diagnosis of MI to death. The cohort of the patients was defined in view of the date at diagnosis, hospitalization and the date at discharge (recovery or in-hospital death due to MI). 20750 patients hospitalized for newly diagnosed MI between April, 2012 and March, 2013 comprised sample size. Totally, 2511 deaths due to MI were obtained. The data on education level (four-level) were collected based on years of schooling. To determine in-hospital mortality rate and the associated factors with mortality, seven statistical models were developed using Cox proportional hazards models.
  
  
  RESULTS
  Of the studied patients, 9611 (6.1%) had no education. in-hospital mortality rate was 8.36 (95% CI: 7.81-8.9) in women and 6.12 (95% CI: 5.83-6.43) in men per 100 person-years. This rate was 5.56 in under 65-year-old patients and 8.37 in over 65-year-old patients. This rate in the patients with no, primary, high school, and academic education was respectively 8.11, 6.11, 4.85 and 5.81 per 100 person-years. Being woman, chest pain prior to arriving in hospital, lack of thrombolytic therapy, right bundle branch block, ventricular tachycardia, smoking and ST-segment elevation myocardial infarction were significantly associated with increased hazard ratio (HR) of death. The adjusted HR of mortality was 1.27 (95% CI: 1.06-1.52), 0.93 (95% CI: 0.77-1.13), 0.72 (95% CI: 0.57-0.91) and 0.82 (95% CI: 0.66-1.01) in the patients with respectively illiterate, primary, secondary and high school education compared to academic education.
  
  
  CONCLUSIONS
  A disparity was noted in post-MI mortality incidence in different educational levels in Iran. HR of death was higher in illiterate patients than in the patients with academic education. Identifying disparities per educational level could contribute to detecting the individuals at high risk, health promotion and care improvement by relevant planning and interventions in clinics and communities.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran. aliahmadi2007@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmadi
authors.affiliation: Cardiology Department, School of Medicine, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. khaledifara@yahoo.com.
authors.forename: Arsalan
authors.initials: A
authors.lastname: Khaledifar
authors.affiliation: Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran. safaneh_s@yahoo.com.
authors.forename: Homeira
authors.initials: H
authors.lastname: Sajjadi
authors.affiliation: Safety Promotion and Injury Prevention Research center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, 7th Floor, 2nd SBMU Headquarters Building, Parvaneh St., Velenjak Area, Chamran High Way, Tehran, Iran. hsoori@yahoo.com.
authors.forename: Hamid
authors.initials: H
authors.lastname: Soori
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004522:Educational Status; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors