Own education, current conditions, parental material circumstances, and risk of myocardial infarction in a former communist country

Objective-To study the association between own education, adult and parenta l circumstances and the risk of myocardial infarction in a former communist country. Design-Population based case-control study. Setting-General population of five districts of the Czech Republic in the a ge group 25-64 years. Participants-Random sample of population (938 men and 1048 women, response rate 77%) served as controls to 282 male and 80 female cases of non-fatal f irst myocardial infarctions. Main outcome measures. Myocardial infarction was defined by the WHO MONICA criteria based on EGG, enzymes and symptoms. The following socioeconomic in dicators were studied: own education, crowded housing conditions (more than one person per room), car ownership, and education and occupation of mothe r and father. Results-There was a weak correlation between education and car ownership, a nd a strong association between own education and parental education and oc cupation. Crowding was not related to other socioeconomic factors. The risk of myocardial infarction was inversely related to education, and was unrel ated to material conditions and parental education and occupation. The age- sex-district adjusted odds ratios for apprenticeship, secondary, and univer sity 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 crowdin g were 1.01 (95% confidence intervals 0.77, 1.34) and 0.92 (0.76, 1.12), re spectively. Further adjustment for parental circumstances and adult height did not change these estimates but adjustment for coronary risk factors red uced the gradient. increased height seemed, anomalously, to confer a small increased risk. Conclusions-In this population, the social gradient in non-fatal myocardial infarction is only apparent for own education. Materialist explanations fo r this gradient seem unlikely but behaviours seem responsible for a part of the gradient.