Conor O'Shea, MD

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• Conor O'Shea, MD
• Research Fellow
• Department of Cardiology
• Duke University

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GUSTO III data analyses

• 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.

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Mortality and education level

• Analysis found a strong inverse correlation
  between mortality at 1 year post-MI and the
  number of years of education.
• Patients with lt 8 years of education (the least
  amount) had a mortality rate gt 19 at 1
  year.
• Patients with gt 16 years education had a
  mortality rate of 3.5.

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Regional differences in mortality

• 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.

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Access to health care

• 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.

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Differences in occupation

• 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).

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Social isolation and mortality

• 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.

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Additional analyses

• 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.