Key result
Less than high school education linked to up to ~61% higher mortality in older Medicare beneficiaries.
Why the study?
Does lower individual education and area income increase mortality and recurrence post-myocardial infarction in an elderly Medicare cohort?
Cohort (n=15,972)
Does lower individual education and area income increase mortality and recurrence post-myocardial infarction in an elderly Medicare cohort?
Effect estimate: HRR 1.61 (95% CI 1.03-2.50)
p-value: p=0.035
Despite universal access to hospital care through Medicare, lower individual education remains significantly associated with increased long-term mortality and recurrence post-MI.
Lower education was associated with higher post-MI mortality despite Medicare; leaves open whether education-targeted strategies could narrow disparities in elderly patients.
BACKGROUND: The Medicare program provides universal access to hospital care for the elderly; however, mortality disparities may still persist in this population. The association of individual education and area income with survival and recurrence post Myocardial Infarction (MI) was assessed in a national sample. METHODS: Individual level education from the National Longitudinal Mortality Study was linked to Medicare and National Death Index records over the period of 1991-2001 to test the association of individual education and zip code tabulation area median income with survival and recurrence post-MI. Survival was partitioned into 3 periods: in-hospital, discharge to 1 year, and 1 year to 5 years and recurrence was partitioned into two periods: 28 day to 1 year, and 1 year to 5 years. RESULTS: First MIs were found in 8,043 women and 7,929 men. In women and men 66-79 years of age, less than a high school education compared with a college degree or more was associated with 1-5 year mortality in both women (HRR 1.61, 95% confidence interval 1.03-2.50) and men (HRR 1.37, 1.06-1.76). Education was also associated with 1-5 year recurrence in men (HRR 1.68, 1.18-2.41, < High School compared with college degree or more), but not women. Across the spectrum of survival and recurrence periods median zip code level income was inconsistently associated with outcomes. Associations were limited to discharge-1 year survival (RR lowest versus highest quintile 1.31, 95% confidence interval 1.03-1.67) and 28 day-1 year recurrence (RR lowest versus highest quintile 1.72, 95% confidence interval 1.14-2.57) in older men. CONCLUSIONS: Despite the Medicare entitlement program, disparities related to individual socioeconomic status remain. Additional research is needed to elucidate the barriers and mechanisms to eliminating health disparities among the elderly.
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Coady et al. (2014) conducted a cohort in First apparent myocardial infarction (n=15,972). Education less than high school vs. College degree or more was evaluated on 1-5 year mortality (women 66-79 years) (HRR 1.61, 95% CI 1.03-2.50, p=0.035). In Medicare beneficiaries aged 66-79 years, having less than a high school education compared with a college degree or more increased 1-5 year mortality in women (HRR 1.61) and men (HRR 1.37).
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