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

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, 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.

Keywords

Neighborhood deprivation epidemiology national registers socioeconomic status

Get full access to this article

View all access options for this article.

References

Diez Roux

. Investigating neighborhood and area effects on health. Am J Public Health 2001; 91: 1783–1789.

Diez Roux

Merkin

Arnett

et al.

Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 2001; 345: 99–106.

Brown

Liang

Vassar

et al.

Neighborhood disadvantage and ischemic stroke: the Cardiovascular Health Study (CHS). Stroke 2011; 42: 3363–3368.

Brown

Guy

Broad

. Individual socio-economic status, community socio-economic status and stroke in New Zealand: a case control study. Soc Sci Med 2005; 61: 1174–1188.

Engstrom

Jerntorp

Pessah-Rasmussen

Hedblad

Berglund

Janzon

. Geographic distribution of stroke incidence within an urban population: relations to socioeconomic circumstances and prevalence of cardiovascular risk factors. Stroke 2001; 32: 1098–1103.

Lisabeth

Diez Roux

Escobar

Smith

Morgenstern

. Neighborhood environment and risk of ischemic stroke: the brain attack surveillance in Corpus Christi (BASIC) Project. Am J Epidemiol 2007; 165: 279–287.

Thrift

Dewey

Sturm

et al.

Greater incidence of both fatal and nonfatal strokes in disadvantaged areas: the Northeast Melbourne Stroke Incidence Study. Stroke 2006; 37: 877–882.

Rosengren

Giang

Lappas

Jern

Toren

Bjorck

. Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010. Stroke 2013; 44: 2388–2393.

Yan

Escarce

Liang

et al.

Exploring psychosocial pathways between neighbourhood characteristics and stroke in older adults: the cardiovascular health study. Age Ageing 2013; 42: 391–397.

10.

Carlsson

Holzmann

et al.

Neighbourhood socioeconomic status and coronary heart disease in individuals between 40 and 50 years. Heart 2016; 102: 775–782.

11.

Aberg

Toren

Nilsson

et al.

Nonpsychotic mental disorders in teenage males and risk of early stroke: a population-based study. Stroke 2016; 47: 814–821.

12.

Cubbin

Sundquist

Ahlen

Johansson

Winkleby

Sundquist

. Neighborhood deprivation and cardiovascular disease risk factors: protective and harmful effects. Scand J Public Health 2006; 34: 228–237.

13.

Sundquist

Johansson

Yang

Sundquist

. Low linking social capital as a predictor of coronary heart disease in Sweden: a cohort study of 2.8 million people. Soc Sci Med 2006; 62: 954–963.

14.

Winkleby

Sundquist

Cubbin

. Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med 2007; 32: 97–106.

15.

Kawakami

Sundquist

. Health-promoting and health-damaging neighbourhood resources and coronary heart disease: a follow-up study of 2165000 people. J Epidemiol Community Health 2011; 65: 866–872.

16.

Tang

Laskowitz

et al.

Neighborhood socioeconomic status and the prevalence of stroke and coronary heart disease in rural China: a population-based study. Int J Stroke 2015; 10: 388–395.

17.

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet 2016.

18.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet 2016; 389(10064): 37–55.

19.

Carlsson

Wandell

Osby

Zarrinkoub

Wettermark

Ljunggren

. High prevalence of diagnosis of diabetes, depression, anxiety, hypertension, asthma and COPD in the total population of Stockholm, Sweden—a challenge for public health. BMC Public Health 2013; 13: 670.

20.

Maaijwee

Rutten-Jacobs

Schaapsmeerders

van Dijk

de Leeuw

. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 2014; 10: 315–325.

21.

Mitchell

Cole

McArdle

et al.

Obesity increases risk of ischemic stroke in young adults. Stroke 2015; 46: 1690–1692.

22.

Carlsson

Wandell

Gasevic

Sundquist

. Neighborhood deprivation and warfarin, aspirin and statin prescription – a cohort study of men and women treated for atrial fibrillation in Swedish primary care. Int J Cardiol 2015; 187: 547–552.

23.

Gage

Waterman

Shannon

Boechler

Rich

Radford

. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285: 2864–2870.

24.

Lip

Frison

Halperin

Lane

. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 2010; 41: 2731–2738.

25.

Lip

Nieuwlaat

Pisters

Lane

Crijns

. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137: 263–272.

26.

Morgenstern

Escobar

Sanchez

et al.

Fast food and neighborhood stroke risk. Ann Neurol 2009; 66: 165–170.

27.

Mandalenakis

Rosengren

Lappas

Eriksson

Hansson

Dellborg

. Ischemic stroke in children and young adults with congenital heart disease. J Am Heart Assoc 2016; 5: 1–8.

28.

Feng

Yang

et al.

Maternal socioeconomic status and the risk of congenital heart defects in offspring: a meta-analysis of 33 studies. PLoS One 2014; 9: e111056.

29.

Lee

Lupo

. Maternal smoking during pregnancy and the risk of congenital heart defects in offspring: a systematic review and metaanalysis. Pediatr Cardiol 2013; 34: 398–407.

30.

Rosengren

Hawken

Ounpuu

et al.

Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 953–962.

31.

Wandell

Carlsson

Gasevic

Sundquist

. Neighbourhood socio-economic status and all-cause mortality in adults with atrial fibrillation: a cohort study of patients treated in primary care in Sweden. Int J Cardiol 2016; 202: 776–781.

32.

Greenland

Knoll

Stamler

et al.

Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290: 891–897.

33.

Khot

Bajzer

et al.

Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290: 898–904.

34.

Hippisley-Cox

Coupland

Vinogradova

Robson

Brindle

. Performance of the QRISK cardiovascular risk prediction algorithm in an independent UK sample of patients from general practice: a validation study. Heart 2008; 94: 34–39.

35.

Collins

Altman

. An independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study. BMJ 2010; 340: c2442.

36.

Wardle

Steptoe

. Socioeconomic differences in attitudes and beliefs about healthy lifestyles. J Epidemiol Community Health 2003; 57: 440–443.

37.

Howard

McClure

Kleindorfer

et al.

Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites. Neurology 2016; 87: 2340–2347.

38.

Almgren

Wilhelmsen

Samuelsson

Himmelmann

Rosengren

Andersson

. Diabetes in treated hypertension is common and carries a high cardiovascular risk: results from a 28-year follow-up. J Hypertens 2007; 25: 1311–1317.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.12 MB