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Original research
Association between annual household income and adverse outcomes in patients who had ischaemic stroke
  1. Yuhan Zang1,
  2. Zhengbao Zhu1,
  3. Mengyao Shi2,
  4. Aili Wang1,
  5. Xuewei Xie3,
  6. Tan Xu1,
  7. Yanbo Peng4,
  8. Pinni Yang1,
  9. Qunwei Li5,
  10. Zhong Ju6,
  11. Deqin Geng7,
  12. Jing Chen2,
  13. Liping Liu3,
  14. Yonghong Zhang1,
  15. Jiang He2
  1. 1 Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China
  2. 2 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
  3. 3 Department of Neurology, Capital Medical University, Beijing, China
  4. 4 Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
  5. 5 Department of Epidemiology, Shandong First Medical University, Jinan, China
  6. 6 Department of Neurology, Kerqin District First People’s Hospital of Tongliao City, Inner Mongolia, China
  7. 7 Department of Neurology, Xuzhou Medical College Affiliated Hospital, Xuzhou, Jiangsu, China
  1. Correspondence to Professor Yonghong Zhang, Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, 215000, China; yhzhang{at}suda.edu.cn

Abstract

Background and purpose The association between annual household income and prognosis of ischaemic stroke remains debatable. We aimed to prospectively investigate the relationship between annual household income and prognosis at 3 months after ischaemic stroke.

Methods We included 3975 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. All participants were categorised into three groups according to annual household income per capita: <¥10 000 (Chinese Yuan Renminbi (RMB)), ¥10 000–19 999 and ≥¥20 000. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset, and secondary outcomes included major disability, death, and vascular events. A meta-analysis was conducted to incorporate the results of the current study and previous studies on the association of income level with outcomes after stroke.

Results Within 3 months after ischaemic stroke, 1002 participants (25.20%) experienced primary outcome (880 major disabilities and 122 deaths). After multivariate adjustment, low annual household income level was associated with increased risk of the primary outcome (OR 1.60; 95% CI: 1.12 to 2.31; Ptrend=0.034) when two extreme groups were compared. The meta-analysis confirmed the significant association between income level and death or major disability after stroke (pooled relative risk for lowest vs highest income level, 1.31 (95% CI: 1.18 to 1.45)).

Conclusions Low annual household income per capita was significantly associated with increased risks of adverse clinical outcomes at 3 months after ischaemic stroke, independently of established risk factors. Further studies from other samples are needed to replicate our findings due to a reason for excluding some patients who had a severe stroke in this study.

Trial registration number ClinicalTrials.gov (http://wwwclinicaltrialsgov) Registry (NCT01840072).

  • stroke
  • inequalities
  • functioning and disability
  • cardiovascular diseases

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jech-2021-216481

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • YZ, ZZ and MS contributed equally.

    • Contributors TX, JC, YHZ and JH conceived and designed the study. TX and YHZ coordinated the study. ZZ, MS, TX, AW, JC, PY, XX, YP, QL, ZJ, DG, LL, JH and YHZ oversaw subjects’ recruitment and monitored gathering of clinical data. YZ, ZZ and YHZ conducted the statistical analysis and prepared the paper. YHZ and JH revised the paper.

    • Funding This study was supported by the National Key Research and Development Program of China (grant: 2016YFC1307300), and a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions, China; Tulane University and Collins C Diboll Private Foundation, both in New Orleans, Louisiana, USA.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.