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Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years : A nationwide cohort study from Sweden

Carlsson, Axel C.; Li, Xinjun LU ; Holzmann, Martin J.; Ärnlöv, Johan; Wändell, Per LU ; Gasevic, Danijela; Sundquist, Jan LU and Sundquist, Kristina LU (2017) In International Journal of Stroke 12(8). p.815-826
Abstract

Objective: We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years. Methods: All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated. Results: A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status,... (More)

Objective: We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years. Methods: All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated. Results: A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78–0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06–1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02–1.23). Conclusions: In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
epidemiology, national registers, Neighborhood deprivation, socioeconomic status
in
International Journal of Stroke
volume
12
issue
8
pages
12 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85030150341
  • wos:000411795000004
ISSN
1747-4930
DOI
10.1177/1747493017702663
language
English
LU publication?
yes
id
9bd3344c-0428-4f1b-9b27-2f85f6d2aa48
date added to LUP
2017-11-28 09:53:46
date last changed
2018-01-16 13:26:37
@article{9bd3344c-0428-4f1b-9b27-2f85f6d2aa48,
  abstract     = {<p>Objective: We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years. Methods: All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated. Results: A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78–0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06–1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02–1.23). Conclusions: In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.</p>},
  author       = {Carlsson, Axel C. and Li, Xinjun and Holzmann, Martin J. and Ärnlöv, Johan and Wändell, Per and Gasevic, Danijela and Sundquist, Jan and Sundquist, Kristina},
  issn         = {1747-4930},
  keyword      = {epidemiology,national registers,Neighborhood deprivation,socioeconomic status},
  language     = {eng},
  month        = {10},
  number       = {8},
  pages        = {815--826},
  publisher    = {Wiley-Blackwell},
  series       = {International Journal of Stroke},
  title        = {Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years : A nationwide cohort study from Sweden},
  url          = {http://dx.doi.org/10.1177/1747493017702663},
  volume       = {12},
  year         = {2017},
}