Heiko Becher1, Frederick Palm2, Annette Aigner2, Anton Safer2, Christian Urbanek2, Florian Buggle2, Caspar Grond-Ginsbach2, Armin J Grau2. 1. From the Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.B., A.A.); Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany (F.P., C.U., F.B., A.J.G.); Institute of Public Health, University of Heidelberg, Heidelberg, Germany (H.B., A.S.); and Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany (C.G.-G.). h.becher@uke.de. 2. From the Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.B., A.A.); Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany (F.P., C.U., F.B., A.J.G.); Institute of Public Health, University of Heidelberg, Heidelberg, Germany (H.B., A.S.); and Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany (C.G.-G.).
Abstract
BACKGROUND AND PURPOSE: The association between socioeconomic status in adulthood and the risk of stroke is well established; however, the independent effects of socioeconomic conditions in different life phases are less understood. METHODS: Within a population-based stroke registry, we performed a case-control study with 470 ischemic stroke patients (cases) aged 18 to 80 years and 809 age- and sex-matched stroke-free controls, randomly selected from the population (study period October 2007 to April 2012). We assessed socioeconomic conditions in childhood, adolescence, and adulthood, and developed a socioeconomic risk score for each life period. RESULTS: Socioeconomic conditions were less favorable in cases regarding paternal profession, living conditions and estimated family income in childhood, school degree, and vocational training in adolescence, last profession, marital status and periods of unemployment in adulthood. Using tertiles of score values, low socioeconomic conditions during childhood (odds ratio 1.77; 95% confidence interval 1.20-2.60) and adulthood (odds ratio 1.74; 95% confidence interval 1.16-2.60) but not significantly during adolescence (odds ratio 1.64; 95% confidence interval 0.97-2.78) were associated with stroke risk after adjustment for risk factors and other life stages. Medical risk factors attenuated the effect of childhood conditions, and lifestyle factors reduced the effect of socioeconomic conditions in adolescence and adulthood. Unfavorable childhood socioeconomic conditions were particularly associated with large artery atherosclerotic stroke in adulthood (odds ratio 2.13; 95% confidence interval 1.24-3.67). CONCLUSIONS: This study supports the hypothesis that unfavorable childhood socioeconomic conditions are related to ischemic stroke risk, independent of established risk factors and socioeconomic status in adulthood, and fosters the idea that stroke prevention needs to begin early in life.
BACKGROUND AND PURPOSE: The association between socioeconomic status in adulthood and the risk of stroke is well established; however, the independent effects of socioeconomic conditions in different life phases are less understood. METHODS: Within a population-based stroke registry, we performed a case-control study with 470 ischemic strokepatients (cases) aged 18 to 80 years and 809 age- and sex-matched stroke-free controls, randomly selected from the population (study period October 2007 to April 2012). We assessed socioeconomic conditions in childhood, adolescence, and adulthood, and developed a socioeconomic risk score for each life period. RESULTS: Socioeconomic conditions were less favorable in cases regarding paternal profession, living conditions and estimated family income in childhood, school degree, and vocational training in adolescence, last profession, marital status and periods of unemployment in adulthood. Using tertiles of score values, low socioeconomic conditions during childhood (odds ratio 1.77; 95% confidence interval 1.20-2.60) and adulthood (odds ratio 1.74; 95% confidence interval 1.16-2.60) but not significantly during adolescence (odds ratio 1.64; 95% confidence interval 0.97-2.78) were associated with stroke risk after adjustment for risk factors and other life stages. Medical risk factors attenuated the effect of childhood conditions, and lifestyle factors reduced the effect of socioeconomic conditions in adolescence and adulthood. Unfavorable childhood socioeconomic conditions were particularly associated with large artery atherosclerotic stroke in adulthood (odds ratio 2.13; 95% confidence interval 1.24-3.67). CONCLUSIONS: This study supports the hypothesis that unfavorable childhood socioeconomic conditions are related to ischemic stroke risk, independent of established risk factors and socioeconomic status in adulthood, and fosters the idea that stroke prevention needs to begin early in life.
Authors: Lars Kellert; Armin Grau; Alessandro Pezzini; Stéphanie Debette; Didier Leys; Valeria Caso; Vincent N Thijs; Anna Bersano; Emmanuel Touzé; Turgut Tatlisumak; Christopher Traenka; Philippe A Lyrer; Stefan T Engelter; Tiina M Metso; Caspar Grond-Ginsbach; Manja Kloss Journal: J Neurol Date: 2018-02-24 Impact factor: 4.849
Authors: Gabriella M Lawrence; Yehiel Friedlander; Ronit Calderon-Margalit; Daniel A Enquobahrie; Jonathan Yinhao Huang; Russell P Tracy; Orly Manor; David S Siscovick; Hagit Hochner Journal: BMJ Open Date: 2017-12-21 Impact factor: 2.692
Authors: Jaakko Leskelä; Milla Pietiäinen; Anton Safer; Markku Lehto; Jari Metso; Ernst Malle; Florian Buggle; Heiko Becher; Jouko Sundvall; Armin J Grau; Pirkko J Pussinen; Frederick Palm Journal: PLoS One Date: 2020-02-21 Impact factor: 3.240
Authors: Ann-Kathrin Ozga; Bernhard Rauch; Frederick Palm; Christian Urbanek; Armin Grau; Heiko Becher; Geraldine Rauch Journal: BMC Public Health Date: 2020-06-01 Impact factor: 3.295