Should years of schooling be used to guide treatment of coronary risk factors?

Kevin Fiscella, Peter Franks

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)469-473
Number of pages5
JournalAnnals of Family Medicine
Volume2
Issue number5
DOIs
StatePublished - Sep 2004
Externally publishedYes

Fingerprint

Coronary Disease
Confidence Intervals
Blood Pressure
Therapeutics
Nutrition Surveys
Smoking
Cholesterol
Sex Education
Social Class
Cohort Studies
Prospective Studies
Guidelines
Education
Mortality

Keywords

  • Coronary heart disease
  • Risk assessment
  • Socioeconomic factors
  • Socioeconomic status

ASJC Scopus subject areas

  • Family Practice

Cite this

Should years of schooling be used to guide treatment of coronary risk factors? / Fiscella, Kevin; Franks, Peter.

In: Annals of Family Medicine, Vol. 2, No. 5, 09.2004, p. 469-473.

Research output: Contribution to journalArticle

@article{e788d828f4f24b5fb5e231f562fdf367,
title = "Should years of schooling be used to guide treatment of coronary risk factors?",
abstract = "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.",
keywords = "Coronary heart disease, Risk assessment, Socioeconomic factors, Socioeconomic status",
author = "Kevin Fiscella and Peter Franks",
year = "2004",
month = "9",
doi = "10.1370/afm.88",
language = "English (US)",
volume = "2",
pages = "469--473",
journal = "Annals of Family Medicine",
issn = "1544-1709",
publisher = "Annals of Family Medicine, Inc",
number = "5",

}

TY - JOUR

T1 - Should years of schooling be used to guide treatment of coronary risk factors?

AU - Fiscella, Kevin

AU - Franks, Peter

PY - 2004/9

Y1 - 2004/9

N2 - 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.

AB - 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.

KW - Coronary heart disease

KW - Risk assessment

KW - Socioeconomic factors

KW - Socioeconomic status

UR - http://www.scopus.com/inward/record.url?scp=7044249773&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=7044249773&partnerID=8YFLogxK

U2 - 10.1370/afm.88

DO - 10.1370/afm.88

M3 - Article

VL - 2

SP - 469

EP - 473

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 5

ER -