Helene Nordahl1, Merete Osler2, Birgitte Lidegaard Frederiksen2, Ingelise Andersen2, Eva Prescott2, Kim Overvad2, Finn Diderichsen2, Naja Hulvej Rod2. 1. From the Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark (H.N., I.A., F.D., N.H.R.); Research Center for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark (M.O.); Clinical Research Centre, Hvidovre University Hospital, Copenhagen, Denmark (B.L.F.); Department of Cardiology, Bispebjerg University Hospital and the Copenhagen City Heart Study, Bispebjerg, Denmark (E.P.); and Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark, and Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (K.O.). henor@sund.ku.dk. 2. From the Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark (H.N., I.A., F.D., N.H.R.); Research Center for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark (M.O.); Clinical Research Centre, Hvidovre University Hospital, Copenhagen, Denmark (B.L.F.); Department of Cardiology, Bispebjerg University Hospital and the Copenhagen City Heart Study, Bispebjerg, Denmark (E.P.); and Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark, and Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (K.O.).
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.
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.
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