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Should Years of Schooling Be Used to Guide Treatment of Coronary Risk Factors?

¹ Departments of Family Medicine, and Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, NY
² Department of Family and Community Medicine, University of California School of Medicine, Davis, Davis, Calif

CORRESPONDING AUTHOR: Kevin Fiscella, MD, MPH, Highland Family Medicine Center 885 South Ave Rochester, NY 14620 Kevin_Fiscella{at}URMC.rochester.edu

PURPOSE We wanted to compare the risk of death from coronary heart disease (CHD) for patients of low socioeconomic status, measured by educational level, with established risk factors.

METHODS We undertook a prospective cohort study. Participants included a representative sample of 6,479 adults aged 25 to 74 years in the United States who were free of CHD at enrollment in the first National Health and Nutrition Examination Survey (NHANES I).

RESULTS Baseline measures included years of education, age, sex, systolic blood pressure, diabetes, total cholesterol level, and smoking. Outcome was death within 10 years from CHD. The relative risk (RR) associated with less than 12 years of education compared with more than 12 years (RR 1.5; 95% confidence interval [CI], 1.2–1.8) was comparable to being male (RR 1.4; 95% CI, 1.2–1.6), smoking (RR 1.4; 95% CI, 1.1–1.6), having a total cholesterol level of greater than 280 mg/dL (RR 1.6; 95% CI, 0.9–2.7), and systolic blood pressure of 130–139 mm Hg (RR 1.6; 95% CI, 1.0–2.4). Findings were comparable for estimates of absolute risk.

CONCLUSIONS Low educational level is associated with comparable risk as established risk factors for CHD mortality. Incorporation of educational level into risk-based guidelines for treatment could potentially reduce socioeconomic disparities in CHD by lowering thresholds for treatment.

Key Words: Socioeconomic factors • coronary heart disease • risk assessment • socioeconomic status

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