Abstract
BackgroundThe present association between socioeconomic status (SES) and stroke is positive in developing communities, but it is negative in developed countries where a positive SES-stroke relationship was recorded several decades ago. We hypothesized that the SES-stroke relationship in developing societies mirrors the trajectory of the Western countries at some stage of economic development. This study aimed to examine whether this inflexion is approaching in China.MethodsThis study comprises of two cross-sectional surveys conducted in the same urban areas of Nanjing, China in 2000 (S2000) and 2011 (S2011) using the same selection criteria (i.e., aged≥35 years) and sampling approach. Physician-diagnosed stroke was the outcome event, while family average income (FAI) was the explanatory variable and tertiled in our anlaysis. Mixed-effects models were used to examine the FAI-stroke association.ResultsOverall, 19,861 (response rate = 90.1%) and 7824 (response rate = 82.8%) participants participated in the S2000 and S2011, respectively. The prevalence of stroke increased by 2.5-folds (95%CI = 2.2, 2.9) from 2000 (2.1%, 95%CI = 1.9%, 2.3%) to 2011 (5.1%, 95%CI = 4.6%, 5.6%) (p < 0.01). Compared with the lower FAI category, the positive association between stroke prevalence and the higher FAI group decreased from 1.99 (95%CI = 1.55, 2.56) in 2000 to 1.49 (95%CI = 1.09, 2.03) in 2011 after control for potential confounders. A similar pattern was also observed for the middle FAI group (1.60, 95% CI = 1.23, 2.08 in 2000 vs. 1.37, 95%CI = 1.01, 1.88 in 2011).ConclusionsThis study revealed that socioeconomic inequalities in stroke were diminishing in regional China during the recent 11-year period, although the SES-stroke association was still positive. Tailored intervention against stroke should currently target on SES-vulnerable people.
Highlights
The present association between socioeconomic status (SES) and stroke is positive in developing communities, but it is negative in developed countries where a positive SES-stroke relationship was recorded several decades ago
Mean value of family average income (FAI) was significantly increased by 2.9 times from 2000 to 2011 among our survey participants (p < 0.001)
There were 44.3% vs. 40.3%, 34.5% vs. 34.0% and 21.2% vs. 25.7% of participants within each age-group (35–49, 50–64 and 65+) for S2000 vs. S2011 (p < 0.05). This was in line with the local census data that the proportion of residents aged 65+ years old within general population significantly increased from16.5% in 2000 to 17.7% in 2011 (p < 0.05)
Summary
The present association between socioeconomic status (SES) and stroke is positive in developing communities, but it is negative in developed countries where a positive SES-stroke relationship was recorded several decades ago. Inflexional results were observed at different socioeconomic stages in Western countries, transiting from a positive association decades ago to a negative link in more recent years [1,2,3,4,5,6,7,8,9,10]. Different SES measures can provide different information on residents’ socioeconomic positions within their communities [11], family average income (FAI) has been shown to be a more sensitive indicator of SES as it can more realistically reflect material measures than educational attainment or occupation [12,13,14]. In China, it has been documented that the prevalence of stroke was positively associated with increasing levels of all SES indices, including family average income, educational attainment and occupation [6]. As China has experienced rapid economic development since the “Open Door” policy launched in 1978, the Gross
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