Abstract:
BACKGROUND AND PURPOSE:Combined effects of socioeconomic position and well-established risk factors on stroke incidence have not been formally investigated. METHODS:In a pooled cohort study of 68 643 men and women aged 30 to 70 years in Denmark, we examined the combined effect and interaction between socioeconomic position (ie, education), smoking, and hypertension on ischemic and hemorrhagic stroke incidence by the use of the additive hazards model. RESULTS:During 14 years of follow-up, 3613 ischemic strokes and 776 hemorrhagic strokes were observed. Current smoking and hypertension were more prevalent among those with low education. Low versus high education was associated with greater ischemic, but not hemorrhagic, stroke incidence. The combined effect of low education and current smoking was more than expected by the sum of their separate effects on ischemic stroke incidence, particularly among men: 134 (95% confidence interval, 49-219) extra cases per 100 000 person-years because of interaction, adjusted for age, cohort study, and birth cohort. There was no clear evidence of interaction between low education and hypertension. The combined effect of current smoking and hypertension was more than expected by the sum of their separate effects on ischemic and hemorrhagic stroke incidence. This effect was most pronounced for ischemic stroke among women: 178 (95% confidence interval, 103-253) extra cases per 100 000 person-years because of interaction, adjusted for age, cohort study, and birth cohort. CONCLUSIONS:Reducing smoking in those with low socioeconomic position and in those with hypertension could potentially reduce social inequality stroke incidence.
journal_name
Strokejournal_title
Strokeauthors
Nordahl H,Osler M,Frederiksen BL,Andersen I,Prescott E,Overvad K,Diderichsen F,Rod NHdoi
10.1161/STROKEAHA.114.005252subject
Has Abstractpub_date
2014-09-01 00:00:00pages
2582-7issue
9eissn
0039-2499issn
1524-4628pii
STROKEAHA.114.005252journal_volume
45pub_type
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