Educational Attainment Level and Risk of Mortality and Cardiopulmonary Outcomes in High‐Risk Patients With Cardiovascular Disease: The INVESTED Trial
Bibliographic record
Abstract
Background Educational attainment level (EAL) is an indicator of socioeconomic status and has been shown to be inversely related with adverse health outcomes. However, the association between EAL and risk of clinical outcomes in high‐risk patients with cardiovascular disease has not been extensively investigated. Methods In the INVESTED (Influenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated Heart Failure) trial, patients with recent heart failure or myocardial infarction hospitalization were randomized 1:1 to high‐dose trivalent or standard‐dose quadrivalent influenza vaccine from September 2016 to January 2019. We examined the association between EAL and risk of clinical outcomes for each participant across all enrolling seasons using adjusted Cox models stratified by trial entry season. Participants were categorized by EAL (≤high school, post‐high school or trade, and ≥college). Results Of the 4912 participants (mean age: 65.5 years, 28% female, 80% White) with EAL information, 43% had high school, 29% had post‐high school or trade, and 28% had ≥college as EAL. Those with higher EAL were more likely to be White or Asian, be married/with long‐term partner, have higher left ventricular ejection fraction, have lower New York Heart Association class, and less likely to have comorbidities and risk factors than those with lower EAL. During follow‐up (median: 9 months), 1706 (35%) participants experienced the composite of all‐cause death or cardiopulmonary hospitalization. Compared with high school, higher EAL was associated with a stepwise decrease in risk (post‐high school or trade: hazard ratio [HR], 0.88 [95% CI, 0.79–0.99]; ≥college: HR, 0.71 [95% CI, 0.63–0.81], P trend <0.001). Conclusions High EAL is significantly associated with a decreased risk of adverse clinical outcomes in patients with high‐risk cardiovascular disease after adjustment for other key risk factors, highlighting the need to consider EAL in risk assessment and target additional resources toward those with low EAL to improve prognosis. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT02787044.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".