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Original research
Association between socioeconomic status and incident stroke in China
  1. Weiju Zhou1,
  2. Ruoling Chen1,
  3. Alex Hopkins1,
  4. Yulong Wang2,
  5. Jie Tang3,
  6. Xiangyan Chen4,
  7. Angela Clifford1,
  8. Yuesong Pan5,6,
  9. Ken Forthby7,
  10. Jindong Ni8,
  11. Duolao Wang9,
  12. Eric Brunner10
  1. 1 Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, West Midlands, UK
  2. 2 Department of Rehabilitation, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, China
  3. 3 Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
  4. 4 Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
  5. 5 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  6. 6 China National Clinical Research Center for Neurological Diseases, Beijing, China
  7. 7 Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  8. 8 Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
  9. 9 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  10. 10 Department of Public Health and Epidemiology, University College London, London, UK
  1. Correspondence to Professor Ruoling Chen, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK; R.Chen{at}wlv.ac.uk

Abstract

Background Little is known about the impact of socioeconomic status (SES) on incidence of stroke in China. This study aimed to examine the association of SES, which was measured by different indicators, with incidence of stroke and gender differences in the association.

Methods and results Two prospective cohort studies were conducted including 2852 participants aged ≥60 years in Anhui province and 3016 participants in four other provinces in China. During a median follow-up of 7.1 years, 211 incident stroke cases occurred in the Anhui cohort. The risk of stroke increased with living in rural areas (adjusted HR 2.49, 95% CI 1.19 to 5.22; women 3.64, 95% CI 1.17 to 11.32, men 2.23, 95% CI 0.81 to 6.19), but not significantly with educational level, occupational class, satisfactory income and financial problems (except for women with low education). The four-province cohort had 113 incident stroke cases over the 3.1 years’ follow-up. The five SES indicators were not significantly associated with incident stroke (except for increased risk in men with high occupation), but additional measurement for actual income showed that incident stroke increased in women with low personal income and in men with high family income. Pooled data from the two cohorts demonstrated the impacts of rural living (1.66, 95% CI 1.08 to 2.57) and having high occupational class (1.56, 95% CI 1.01 to 2.38), and gender differences for women with low education (2.26, 95% CI 1.19 to 4.27).

Conclusions Rural living and being female with low SES are associated with increased stroke risk in China. Strategies to improve public health in the rural communities and gender-specific targets for health inequality should be an integral component of stroke interventions.

  • socio-economic
  • inequalities
  • stroke
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/jech-2019-213515

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    Footnotes

    • Contributors RC (guarantor) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. RC obtained funding, conceptualised and designed the study, supervised the analyses and revised the manuscript. WZ had full access to all the data in the study, managed the database, performed the analyses and drafted the initial manuscript. AH, YW, XC, AC, KF and JN commented and revised the manuscript and interpreted the findings. JT, YP and DW provided statistical support and input, interpreted the data and commented on the manuscript. EB commented and supported the data analysis, interpreted the findings and provided critical revision of the manuscript. All authors approve the final version of the manuscript.

    • Funding The research was funded by the BUPA Foundation (grants numbers 45NOV06 and TBF-M09-05) and the Alzheimer’s Research UK (grant number ART/PPG2007B/2) for the two cohorts’ data collection.

    • Disclaimer The funders had no role in the study design, data analysis and interpretation, the writing of the manuscript and the decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approvals for the Anhui cohort study and the four-province study were obtained from the Ethics Committees of University College London, and School of Health and Wellbeing at University of Wolverhampton, UK, and the Research Ethics Committee of Anhui Medical University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.