TY - JOUR
T1 - Educational and homeownership inequalities in stroke incidence: A population-based longitudinal study of mid-aged women
AU - Jackson, Caroline A.
AU - Jones, Mark
AU - Mishra, Gita D.
N1 - Funding Information:
The ALSWH is funded by the Australian Commonwealth Department of Health and Ageing. C.A.J., M.J. and G.D.M. were supported by the Australian National Health and Medical Research Council (grant number: APP1000986). The funding organization had no role in the design and conduct of the study; in data collection, analysis and interpretation of results or in preparation of the manuscript. C.A.J. designed the study, carried out the statistical analyses, drafted the manuscript and is guarantor. G.D.M. and M.J. advised on the statistical analyses and critically reviewed the manuscript. All authors were involved in the interpretation of the data and approved the final version.
PY - 2014/4
Y1 - 2014/4
N2 - Background: We aimed to determine which socioeconomic status measures are associated with stroke risk in mid-aged women and assess the contribution of lifestyle, biological and psychosocial factors to observed associations. Methods: We included women born in 1946-51 from the Australian Longitudinal Study on Women's Health, who were surveyed every 3 years. Using generalized estimating equation analysis, we determined the association between socioeconomic status and stroke at the subsequent survey, adjusting for time-varying covariates. For significant associations, we calculated the contribution of individual mediating factors in explaining these associations. Results: Among 11 468 women aged 47-52 years, 177 strokes occurred during a 12-year follow-up. Education (odds ratio lowest vs. highest 2.45, 95% confidence interval: 1.40-4.30) and homeownership, but not occupation or managing on income, were significantly associated with stroke. After full adjustment, the overall association between education and stroke was non-significant. Lifestyle (smoking, exercise, alcohol and body mass index), biological (hypertension, diabetes, heart disease and hysterectomy/oophorectomy) and psychosocial (depression and marital status) factors explained 38% of the association in the lowest versus highest education groups. Lifestyle and biological factors together accounted for 34%. Mediators accounted for 29% of the association between homeownership and stroke, with lifestyle and psychosocial factors responsible for most of this attenuation. However, a significant association remained in fully adjusted models (odds ratio non-homeowner vs. homeowner 1.63, 95% confidence interval: 1.12-2.38). Conclusions: Lower education level is associated with increased stroke risk in mid-aged women, and is partially mediated by known risk factors, particularly lifestyle and biological factors. Non-homeownership is associated with increased stroke risk, but the underlying mechanism is unclear.
AB - Background: We aimed to determine which socioeconomic status measures are associated with stroke risk in mid-aged women and assess the contribution of lifestyle, biological and psychosocial factors to observed associations. Methods: We included women born in 1946-51 from the Australian Longitudinal Study on Women's Health, who were surveyed every 3 years. Using generalized estimating equation analysis, we determined the association between socioeconomic status and stroke at the subsequent survey, adjusting for time-varying covariates. For significant associations, we calculated the contribution of individual mediating factors in explaining these associations. Results: Among 11 468 women aged 47-52 years, 177 strokes occurred during a 12-year follow-up. Education (odds ratio lowest vs. highest 2.45, 95% confidence interval: 1.40-4.30) and homeownership, but not occupation or managing on income, were significantly associated with stroke. After full adjustment, the overall association between education and stroke was non-significant. Lifestyle (smoking, exercise, alcohol and body mass index), biological (hypertension, diabetes, heart disease and hysterectomy/oophorectomy) and psychosocial (depression and marital status) factors explained 38% of the association in the lowest versus highest education groups. Lifestyle and biological factors together accounted for 34%. Mediators accounted for 29% of the association between homeownership and stroke, with lifestyle and psychosocial factors responsible for most of this attenuation. However, a significant association remained in fully adjusted models (odds ratio non-homeowner vs. homeowner 1.63, 95% confidence interval: 1.12-2.38). Conclusions: Lower education level is associated with increased stroke risk in mid-aged women, and is partially mediated by known risk factors, particularly lifestyle and biological factors. Non-homeownership is associated with increased stroke risk, but the underlying mechanism is unclear.
UR - http://www.scopus.com/inward/record.url?scp=84897429499&partnerID=8YFLogxK
U2 - 10.1093/eurpub/ckt073
DO - 10.1093/eurpub/ckt073
M3 - Article
C2 - 23788011
AN - SCOPUS:84897429499
SN - 1101-1262
VL - 24
SP - 231
EP - 236
JO - European Journal of Public Health
JF - European Journal of Public Health
IS - 2
ER -
