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J Clin Epidemiol. 2002 Aug;55(8):741-7.

The influence of economic development on the association between education and the risk of acute myocardial infarction and stroke.

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Cardiovascular Studies Unit, Department of Clinical Pharmacology, Imperial College of Science, Technology and Medicine, St. Mary's Campus, London W2 1PG, UK.


Rates of myocardial infarction and stroke increase as countries "develop." These disorders emerge among higher socio-economic groups, but once "developed," most events occur in lower socio-economic groups. We evaluated the association between education as a measure of socio-economic status and risk of acute myocardial infarction (AMI) and stroke in regions at various stages of development and between stroke risk and life expectancy. The study comprised 2,478 cases of AMI or stroke and 6,819 controls among women aged 19-49, from Africa, Asia, Latin America, and Eastern Europe. Compared to those with high educational attainment, stroke risk was reduced among less educated women in Africa, but was significantly higher in the other three regions. Low education was associated with increased risk of AMI in Eastern Europe but not in the other three regions combined. Educationally related stroke risk was positively correlated with national life expectancy.

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