Education level and outcomes after acute myocardial infarction in China

Xiqian Huo, Rohan Khera, Lihua Zhang, Jeph Herrin, Xueke Bai, Qianying Wang, Yuan Lu, Khurram Nasir, Shuang Hu, Jing Li, Xi Li, Xin Zheng, Frederick A. Masoudi, John A. Spertus, Harlan M. Krumholz, Lixin Jiang

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective To assess the association between educational attainment and acute myocardial infarction (AMI) outcomes in China to inform future healthcare interventions. Methods We used data from the China Patient-centred Evaluative Assessment of Cardiac Events-Prospective AMI study of 3369 consecutive patients hospitalised with AMI from 53 hospitals. Educational attainment was categorised as: high (senior high school, college or postgraduate degree), intermediate (junior high school) or low (primary school or illiterate). We used survival models to assess the relationship between education and 1-year major adverse cardiovascular events (MACE), all-cause mortality, both unadjusted and after adjustment for demographic characteristics and cardiovascular risk factors. Results The median participant age was 61 (52, 69) years, 23.2% were women, and 33.3% had high, 32.4% intermediate and 34.3% low educational attainment. In unadjusted analysis, compared with high educational attainment, low educational attainment was associated with a higher 1-year risk of MACE (HR 2.41, 95% CI 1.72 to 3.37) and death (HR for low vs high education 3.09, 95% CI 1.69 to 5.65). In risk-adjusted analyses, the association between education and death was attenuated and no longer statistically significant (adjusted HR 1.41, 95% CI 0.74 to 2.69, p=0.30). However, the risk of 1-year MACE (adjusted HR 1.68, 95% CI 1.18 to 2.41, p=0.004) remained significantly greaterin low educational attainment group. Conclusions In a national Chinese cohort of patients hospitalised with AMI, low educational attainment was associated with a higher risk of adverse events in the year following discharge. This association highlights the need to consider interventions to improve AMI outcomes in adults with low levels of education. Clinical trial registration NCT01624909; Results.

Original languageEnglish (US)
Pages (from-to)946-952
Number of pages7
Issue number12
StatePublished - Jun 1 2019


  • acute myocardial infarction
  • quality and outcomes of care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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