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Conor O'Shea, MD Research FellowDepartment of CardiologyDuke University

GUSTO III data analyses

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Data analysis was carried out on more than 10 000 patient records drawn from GUSTO III between 1994 and 1995.

Educational level was determined based on whether a patient had attended university, college, or high school.

Educational definitions were normalized for different regions of the world.

Mortality and education level

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Analysis found a strong inverse correlation between mortality at 1 year post-MI and the number of years of education.

Patients with < 8 years of education (the least amount) had a mortality rate > 19% at 1 year.

Patients with > 16 years education had a mortality rate of 3.5%.

Regional differences in mortality

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Data were analyzed from countries with more than 500 patients enrolled (9 countries altogether).

The difference in mortality between those with less and more education differed from country to country.

Differences were greater in the United Kingdom and Germany than they were in the US.

Access to health care

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The reasons behind the differences in mortality from country to country – with respect to education – are unclear.

The difficulty may arise in initially gaining access to health care.

Differences in occupation

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Differences in mortality were also found among different jobs and occupations.

Homemakers, for example, had a 13.5% 1-year mortality compared to 3.5% among managers.

These results may reflect the educational level of patients schooled from 1940-1950 (a relatively older cohort).

Social isolation and mortality

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An additional analysis of more than 13 000 patients showed that patients who live alone have a higher risk profile upon presentation to the hospital.

The elevated 30-day and 1-year mortality in this group is due to their risk profile and is not due to social isolation.

However, social isolation and depression in tandem may be key factors in determining prognosis post-MI.

Additional analyses

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Education and mortality results remain consistent when both smoking status and gender are controlled.

Patients with a higher level of education were more likely to quit smoking than those with less education.

Analyses continue, looking at intervention strategies and discharge medications in relation to socioeconomic status and regional differences.