Abstract
BackgroundNeighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries.MethodsThis study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40–69 years. A Cox proportional-hazard regression model using a shared frailty model was applied.ResultsThe adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04–1.29), 1.12 (95% CI, 1.00–1.26), 1.18 (95% CI, 1.02–1.35), and 1.19 (95% CI, 1.01–1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified.ConclusionsOur results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke.
Highlights
A wealth of evidence has consistently demonstrated that the level of neighborhood deprivation is an influential factor in the risk of cardiovascular disease.[1]
We observed that neighborhood deprivation level was associated with total stroke incidence after adjustment for individual socioeconomic indicators, and living in more deprived neighborhoods increased the risk of developing stroke regardless of individual socioeconomic conditions
The association remained after adjustment for individual socioeconomic indicators, which suggests that the neighborhood deprivation level has an impact on disparities in stroke incidence in Japanese society
Summary
A wealth of evidence has consistently demonstrated that the level of neighborhood deprivation is an influential factor in the risk of cardiovascular disease.[1]. Evidence of social inequalities in cardiovascular disease has been accumulating in Japan[11]; several studies have shown differences in mortality, morbidity, and risk factors for cardiovascular disease—stroke in particular—according to indicators of individual socioeconomic conditions.[12,13,14,15,16] Regional inequalities in health have been repeatedly reported. A recently-conducted multi-level study, indicated that higher municipal deprivation levels were associated with increased risk of cardiovascular mortality among men.[22] far, no prospective studies have been conducted to examine the impact of finer neighborhood-level socioeconomic conditions on individual risk of developing cardiovascular diseases. Conclusions: Our results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke
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