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School and vocational training, vocational status and myocardial infarct: A study with data of the mandatory health insurance
Das Gesundheitswesen, 1999, 61. Jahrgang (Heft 1), Seite 20-26, Stuttgart: Thieme, ISSN: 0941-3790
We analysed whether indicators of social status (education and training, occupational grade) are associated with a first acute myocardial infarction (ICD-410) between 1987 and 1996. Analyses were based on data from a statutory health insurance (Allgemeine Ortskrankenkasse) in Northrhine-Westfalia, Germany. 132, 255 men and women aged 30-69 years who were employed or were employed before retirement have been included in the investigation.
The cumulated incidence of first myocardial infarction was 2.1% (n = 1938) among men and 0.8% (n = 327) among women. After adjustment for age and length of the observation period an increasing infarction risk with decreasing social status was observed in men. Respective odds ratios (OR) were 3.96 in the lowest educational and training group and 3.41 in the medium group as compared to men with the highest educational and training level. With regard to occupational grade respective odds ratios were 1.92 for the lowest (semi- and unskilled workers) and 1.73 for the medium group (skilled workers) compared to those with the highest grade level (skilled non-manuals, intermediate, professionals).
Among women the risk was 1. 47 in the lowest educational and training group and 1.03 in the medium group. In semi- and unskilled women the OR was 1.58 and 1.67 in skilled women as compared to the highest occupational group. Although associations were observed between indicators of social status and risk of first myocardial infarction it is concluded that further research is needed due to the selection of the population under study with regard to education and occupational grade. Future research activities should concentrate on health insurances for skilled non-manual employees.
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