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kodovác, Michael Marmota
a International Centre
for Health and Society, Department of Epidemiology and Public Health,
University College London, London, b Department of Health Care and Epidemiology,
University of British Columbia, Vancouver, Canada, c Department of Preventive Cardiology, Institute
of Clinical and Experimental Medicine, Prague, Czech Republic
Correspondence to: Dr M Bobak, International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT
Accepted for publication 4 July 1999
OBJECTIVE
To study the
association between own education, adult and parental circumstances and
the risk of myocardial infarction in a former communist country.
DESIGNPopulation
based case-control study.
SETTINGGeneral
population of five districts of the Czech Republic in the age group
25-64 years.
PARTICIPANTSRandom
sample of population (938 men and 1048 women, response rate 77%)
served as controls to 282 male and 80 female cases of non-fatal first
myocardial infarctions.
MAIN OUTCOME
MEASURESMyocardial infarction was defined by the
WHO MONICA criteria based on ECG, enzymes and symptoms. The following
socioeconomic indicators were studied: own education, crowded
housing conditions (more than one person per room), car ownership, and
education and occupation of mother and father.
RESULTSThere was a
weak correlation between education and car ownership, and a strong
association between own education and parental education and
occupation. Crowding was not related to other socioeconomic factors.
The risk of myocardial infarction was inversely related to education,
and was unrelated to material conditions and parental education and
occupation. The age-sex-district adjusted odds ratios for
apprenticeship, secondary, and university education, compared with
primary education, were 0.87, 0.74 and 0.46, respectively (p for trend
0.009); odds ratios for car ownership and crowding were 1.01 (95%
confidence intervals 0.77, 1.34) and 0.92 (0.76, 1.12), respectively.
Further adjustment for parental circumstances and adult height did not
change these estimates but adjustment for coronary risk factors reduced
the gradient. Increased height seemed, anomalously, to confer a small
increased risk.
CONCLUSIONSIn this
population, the social gradient in non-fatal myocardial infarction is
only apparent for own education. Materialist explanations for this
gradient seem unlikely but behaviours seem responsible for a part of
the gradient.
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