Abstract
Introduction: The incidence of stroke has decreased in Sweden as well as in most developed countries, but a high number of migrants have arrived in Sweden, during the last decades, which may have influenced the incidence. Aim: The aim of this study was to examine the incidence of stroke in women, born outside as well as in Sweden. Furthermore, the aim was to examine how socio-economic factors, smoking, and physical activity could modify the risk for stroke. Method: Data from the “Malmö Diet and Cancer Study” was used for the analysis. In total, 16,857 women were included (14,849 of them born in and 2,008 born outside Sweden), aged 45 - 73 years with a mean age of 57.4 years. Result. A significantly increased relative risk (RR) was found for the incidence of stroke for current smokers in both Swedish-born and migrant women. In Swedish-born women the RR was 1.98 (CI: 1.66 - 2.36) and for migrant women the RR was 1.83(CI: 1.13 - 2.96). The adjusted relative risk for the incidence of stroke in Swedish-born women performing moderate/high physical activity was RR 0.71 (CI: 0.61 - 0.84) and for migrant women it was RR 0.77 (CI: 0.49 - 1.20). The relative risk in relation to low socio-economic circumstances (SES) was significant only for Swedish-born women (RR 0.85 [CI: 0.73 - 0.99]). Among currently smoking Swedish-born women with a low SES the RR was 1.27 (CI: 1.03 - 1.57) in comparison with smoking migrant women, whose RR was 1.68 (CI: 0.92 - 3.09). Conclusion: No differences were found indicating that migrant women in this population had a higher risk as compared to Swedish-born women. However, migrant smoking women were more vulnerable to stroke compared to Swedish-born women. Physical activity was effective in reducing the risk of stroke among the total population and especially in the Swedish-born women. To increase physical activity in middle-aged women, in both migrant and Swedish-born women, is a highly recommended public health strategy.
Highlights
The incidence of stroke has decreased in Sweden as well as in most developed countries, but a high number of migrants have arrived in Sweden, during the last decades, which may have influenced the incidence
During the follow-up, 705 (4.7%) women born in Sweden and 90 (4.5%) women born outside Sweden developed stroke (p = 0.60) (Figure 1)
This study revealed that women who had never smoked had less probability of getting a stroke compared to ex-smokers and current smokers in both groups of Swedish-born and non-Swedish-born women
Summary
The incidence of stroke has decreased in Sweden as well as in most developed countries, but a high number of migrants have arrived in Sweden, during the last decades, which may have influenced the incidence. A significantly increased relative risk (RR) was found for the incidence of stroke for current smokers in both Swedish-born and migrant women. The adjusted relative risk for the incidence of stroke in Swedish-born women performing moderate/high physical activity was RR 0.71 (CI: 0.61 - 0.84) and for migrant women it was RR 0.77 (CI: 0.49 1.20). Physical activity was effective in reducing the risk of stroke among the total population and especially in the Swedish-born women. According to the Swedish National Board of Health and Welfare, a reduction in the incidence of mortality due to cardiovascular diseases and stroke in both male and female inhabitants in Sweden between 1987 and 2012 has been reported, from 128 to 49 per 100,000 women and 352 to 113 per 100,000 men among the age group 15 - 74 [4]
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