Skip to main content
Top
Published in: BMC Public Health 1/2008

Open Access 01-12-2008 | Research article

Impact of socio-economic factors on stroke prevalence among urban and rural residents in Mainland China

Authors: Fei Xu, Lap Ah Tse, XiaoMei Yin, Ignatius Tak-sun Yu, Sian Griffiths

Published in: BMC Public Health | Issue 1/2008

Login to get access

Abstract

Background

An inverse relationship between better socioeconomic status (total household income, education or occupation) and stroke has been established in developed communities, but family size has generally not been considered in the use of socioeconomic status indices. We explored the utility of Family Average Income (FAI) as a single index of socioeconomic status to examine the association with stroke prevalence in a region of China, and we also compared its performance as a single index of socioeconomic status with that of education and occupation.

Methods

A population-based cross-sectional study was conducted in Nanjing municipality of China during the period between October 2000 and March 2001. A total of 45 administrative villages were randomly selected using a multi-stage sampling approach and all regular local residents aged 35 years or above were included. Descriptive statistics and logistic regression models were used in analysis.

Results

The overall prevalence of diagnosed stroke was 1.54% in all 29,340 eligible participants. An elevated prevalence of stroke was associated with increasing levels of FAI. After adjustment for basic demographic variables (age, urban/rural area and gender) and a group of defined conventional risk factors, this gradient still remained significant, with participants in the highest (OR = 1.94, 95% CI = 1.40, 2.70) and middle (OR = 1.43, 95% CI = 1.01, 2.02) categories of FAI having higher risks compared with the lowest category. A significantly elevated OR of stroke prevalence was found in white collar workers compared to blue collar workers, while no significant relationship was observed with education.

Conclusion

Our study consistently revealed that the prevalence of stroke was associated with increasing levels of all SES indices, including FAI, education, and occupation. However, a significant gradient was only observed with FAI after controlling for important confounding factors. The findings suggested that, compared with occupation and education, FAI could be used as a more sensitive index of socio-economic status for public health studies in China.
Literature
1.
go back to reference Cox AM, McKevitt C, Rudd AG, Wolfe CD: Socioeconomic status and stroke. Lancet Neurol. 2006, 5: 181-188. 10.1016/S1474-4422(06)70351-9.CrossRefPubMed Cox AM, McKevitt C, Rudd AG, Wolfe CD: Socioeconomic status and stroke. Lancet Neurol. 2006, 5: 181-188. 10.1016/S1474-4422(06)70351-9.CrossRefPubMed
2.
go back to reference Hart CL, Hole DJ, Smith GD: Influence of socioeconomic circumstances in early and later life on stroke risk among men in a Scottish cohort study. Stroke. 2000, 31: 2093-2097.CrossRefPubMed Hart CL, Hole DJ, Smith GD: Influence of socioeconomic circumstances in early and later life on stroke risk among men in a Scottish cohort study. Stroke. 2000, 31: 2093-2097.CrossRefPubMed
3.
go back to reference Kleindorfer DO, Lindsell C, Broderick J, Flaherty ML, Woo D, Alwell K, Moomaw CJ, Ewing I, Schneider A, Kissela BM: Impact of socioeconomic status on stroke incidence: a population-based study. Ann Neurol. 2006, 60: 480-484. 10.1002/ana.20974.CrossRefPubMed Kleindorfer DO, Lindsell C, Broderick J, Flaherty ML, Woo D, Alwell K, Moomaw CJ, Ewing I, Schneider A, Kissela BM: Impact of socioeconomic status on stroke incidence: a population-based study. Ann Neurol. 2006, 60: 480-484. 10.1002/ana.20974.CrossRefPubMed
4.
go back to reference Thrift AG, Dewey HM, Sturm JW, Paul SL, Gilligan AK, Srikanth VK, Macdonell RA, McNeil JJ, Macleod MR, Donnan GA: Greater incidence of both fatal and nonfatal strokes in disadvantaged areas: the Northeast Melbourne Stroke Incidence Study. Stroke. 2006, 37: 877-882. 10.1161/01.STR.0000202588.95876.a7.CrossRefPubMed Thrift AG, Dewey HM, Sturm JW, Paul SL, Gilligan AK, Srikanth VK, Macdonell RA, McNeil JJ, Macleod MR, Donnan GA: Greater incidence of both fatal and nonfatal strokes in disadvantaged areas: the Northeast Melbourne Stroke Incidence Study. Stroke. 2006, 37: 877-882. 10.1161/01.STR.0000202588.95876.a7.CrossRefPubMed
5.
go back to reference Bos Van den GA, Smits JP, Westert GP, van Straten A: Socioeconomic variations in the course of stroke: unequal health outcomes, equal care?. J Epidemiol Community Health. 2002, 56: 943-948. 10.1136/jech.56.12.943.CrossRefPubMedPubMedCentral Bos Van den GA, Smits JP, Westert GP, van Straten A: Socioeconomic variations in the course of stroke: unequal health outcomes, equal care?. J Epidemiol Community Health. 2002, 56: 943-948. 10.1136/jech.56.12.943.CrossRefPubMedPubMedCentral
6.
go back to reference Avendano M, Kawachi I, Van Lenthe F, Boshuizen HC, Mackenbach JP, Bos Van den GA, Fay ME, Berkman LF: Socioeconomic status and stroke incidence in the US elderly: the role of risk factors in the EPESE study. Stroke. 2006, 37: 1368-1373. 10.1161/01.STR.0000221702.75002.66.CrossRefPubMed Avendano M, Kawachi I, Van Lenthe F, Boshuizen HC, Mackenbach JP, Bos Van den GA, Fay ME, Berkman LF: Socioeconomic status and stroke incidence in the US elderly: the role of risk factors in the EPESE study. Stroke. 2006, 37: 1368-1373. 10.1161/01.STR.0000221702.75002.66.CrossRefPubMed
8.
go back to reference Hart CL, Hole DJ, Smith GD: The contribution of risk factors to stroke differentials, by socioeconomic position in adulthood: the Renfrew/Paisley study. Am J Public Health. 2000, 90: 1788-1791.CrossRefPubMedPubMedCentral Hart CL, Hole DJ, Smith GD: The contribution of risk factors to stroke differentials, by socioeconomic position in adulthood: the Renfrew/Paisley study. Am J Public Health. 2000, 90: 1788-1791.CrossRefPubMedPubMedCentral
9.
go back to reference Power C, Hypponen E, Davey Smith G: Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort. Am J Public Health. 2005, 95: 1396-1402. 10.2105/AJPH.2004.047340.CrossRefPubMedPubMedCentral Power C, Hypponen E, Davey Smith G: Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort. Am J Public Health. 2005, 95: 1396-1402. 10.2105/AJPH.2004.047340.CrossRefPubMedPubMedCentral
10.
go back to reference Morris RW, Whincup PH, Emberson JR, Lampe FC, Walker M, Shaper AG: North-south gradients in Britain for stroke and CHD: are they explained by the same factors?. Stroke. 2003, 34: 2604-2609. 10.1161/01.STR.0000092489.98235.1D.CrossRefPubMed Morris RW, Whincup PH, Emberson JR, Lampe FC, Walker M, Shaper AG: North-south gradients in Britain for stroke and CHD: are they explained by the same factors?. Stroke. 2003, 34: 2604-2609. 10.1161/01.STR.0000092489.98235.1D.CrossRefPubMed
11.
go back to reference Song YM, Ferrer RL, Cho SI, Sung J, Ebrahim S, Davey Smith G: Socioeconomic status and cardiovascular disease among men: the Korean national health service prospective cohort study. Am J Public Health. 2006, 96: 152-159. 10.2105/AJPH.2004.061853.CrossRefPubMedPubMedCentral Song YM, Ferrer RL, Cho SI, Sung J, Ebrahim S, Davey Smith G: Socioeconomic status and cardiovascular disease among men: the Korean national health service prospective cohort study. Am J Public Health. 2006, 96: 152-159. 10.2105/AJPH.2004.061853.CrossRefPubMedPubMedCentral
12.
go back to reference Kuper H, Adami HO, Theorell T, Weiderpass E: The socioeconomic gradient in the incidence of stroke: a prospective study in middle-aged women in Sweden. Stroke. 2007, 38: 27-33. 10.1161/01.STR.0000251805.47370.91.CrossRefPubMed Kuper H, Adami HO, Theorell T, Weiderpass E: The socioeconomic gradient in the incidence of stroke: a prospective study in middle-aged women in Sweden. Stroke. 2007, 38: 27-33. 10.1161/01.STR.0000251805.47370.91.CrossRefPubMed
13.
go back to reference Robbins JM, Vaccarino V, Zhang H, Kasl SV: Socioeconomic status and type 2 diabetes in African American and non-Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey. Am J Public Health. 2001, 91: 76-83.CrossRefPubMedPubMedCentral Robbins JM, Vaccarino V, Zhang H, Kasl SV: Socioeconomic status and type 2 diabetes in African American and non-Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey. Am J Public Health. 2001, 91: 76-83.CrossRefPubMedPubMedCentral
14.
go back to reference Xu F, Yin XM, Zhang M, Leslie E, Ware R, Owen N: Cigarette smoking is negatively associated with family average income among urban and rural men in regional Mainland China. International Journal of Mental Health and Addiction. 2007, 5 (1): 17-23. 10.1007/s11469-006-9043-7.CrossRef Xu F, Yin XM, Zhang M, Leslie E, Ware R, Owen N: Cigarette smoking is negatively associated with family average income among urban and rural men in regional Mainland China. International Journal of Mental Health and Addiction. 2007, 5 (1): 17-23. 10.1007/s11469-006-9043-7.CrossRef
15.
go back to reference Xu F, Yin XM, Zhang M, Leslie E, Ware R, Owen N: Family Average Income and Body Mass Index above the Healthy Weight Range among Urban and Rural Residents in Regional Mainland China. Public Health Nutrition. 2005, 8 (1): 47-51. 10.1079/PHN2005653.CrossRefPubMed Xu F, Yin XM, Zhang M, Leslie E, Ware R, Owen N: Family Average Income and Body Mass Index above the Healthy Weight Range among Urban and Rural Residents in Regional Mainland China. Public Health Nutrition. 2005, 8 (1): 47-51. 10.1079/PHN2005653.CrossRefPubMed
16.
go back to reference Xu F, Yin XM, Zhang M, Leslie E, Ware R, Owen N: Family Average Income and Diagnosed Type 2 Diabetes among Urban and Rural Residents in Regional Mainland China. Diabetic Medicine. 2006, 23 (11): 1239-1246. 10.1111/j.1464-5491.2006.01965.x.CrossRefPubMed Xu F, Yin XM, Zhang M, Leslie E, Ware R, Owen N: Family Average Income and Diagnosed Type 2 Diabetes among Urban and Rural Residents in Regional Mainland China. Diabetic Medicine. 2006, 23 (11): 1239-1246. 10.1111/j.1464-5491.2006.01965.x.CrossRefPubMed
17.
go back to reference Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, Haase N, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O'Donnell CJ, Roger V, Rumsfeld J, Sorlie P, Steinberger J, Thom T, Wasserthiel-Smoller S, Hong Y: Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007, 115 (5): 69-171. 10.1161/CIRCULATIONAHA.106.179918.CrossRef Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, Haase N, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O'Donnell CJ, Roger V, Rumsfeld J, Sorlie P, Steinberger J, Thom T, Wasserthiel-Smoller S, Hong Y: Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2007, 115 (5): 69-171. 10.1161/CIRCULATIONAHA.106.179918.CrossRef
18.
go back to reference Menzies Centre for Population Health Research: Profile of cardiovascular diseases, diabetes mellitus and associated risk factors in the western pacific region. 1999, Manila; World Health Organization Menzies Centre for Population Health Research: Profile of cardiovascular diseases, diabetes mellitus and associated risk factors in the western pacific region. 1999, Manila; World Health Organization
19.
go back to reference Zhang XF, Attia J, D'Este C, Yu XH: Prevalence and Magnitude of Classical Risk Factors for Stroke in a Cohort of 5092 Chinese Steelworkers Over 13.5 Years of Follow-up. Stroke. 2004, 35: 1052-1056. 10.1161/01.STR.0000125305.12859.ff.CrossRefPubMed Zhang XF, Attia J, D'Este C, Yu XH: Prevalence and Magnitude of Classical Risk Factors for Stroke in a Cohort of 5092 Chinese Steelworkers Over 13.5 Years of Follow-up. Stroke. 2004, 35: 1052-1056. 10.1161/01.STR.0000125305.12859.ff.CrossRefPubMed
20.
go back to reference National Work Group of Hypertension Survey: Prevalence and Risk Factors of Stroke and Miocardial Infarction in China. Chinese Journal of Hypertension. 1995, 3 (suppl): 7-13. National Work Group of Hypertension Survey: Prevalence and Risk Factors of Stroke and Miocardial Infarction in China. Chinese Journal of Hypertension. 1995, 3 (suppl): 7-13.
21.
go back to reference Wu ZS, Yao CH, Zhao D, Wu GX, Wang W, Liu J, Zeng ZH, Wu YK: Sino-MONICA Project: A Collaborative Study on Trends and Determinants in Cardiovascular Diseases in China, Part I: Morbidity and Mortality Monitoring. Circulation. 2001, 103: 462-468. 10.1161/hc2301.091931.CrossRefPubMed Wu ZS, Yao CH, Zhao D, Wu GX, Wang W, Liu J, Zeng ZH, Wu YK: Sino-MONICA Project: A Collaborative Study on Trends and Determinants in Cardiovascular Diseases in China, Part I: Morbidity and Mortality Monitoring. Circulation. 2001, 103: 462-468. 10.1161/hc2301.091931.CrossRefPubMed
22.
go back to reference Feinstein JS: The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993, 71: 279-322. 10.2307/3350401.CrossRefPubMed Feinstein JS: The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993, 71: 279-322. 10.2307/3350401.CrossRefPubMed
23.
go back to reference MacIntyre S: The Black Report and beyond: what are the issues?. Soc Sci Med. 1997, 44: 723-745. 10.1016/S0277-9536(96)00183-9.CrossRefPubMed MacIntyre S: The Black Report and beyond: what are the issues?. Soc Sci Med. 1997, 44: 723-745. 10.1016/S0277-9536(96)00183-9.CrossRefPubMed
24.
go back to reference Kunst AE, Rios MD, Groenhof F, Mackenbach JP: Socioeconomic Inequalities in Stroke Mortality Among Middle-Aged Men An International Overview. Stroke. 1998, 29: 2285-2291.CrossRefPubMed Kunst AE, Rios MD, Groenhof F, Mackenbach JP: Socioeconomic Inequalities in Stroke Mortality Among Middle-Aged Men An International Overview. Stroke. 1998, 29: 2285-2291.CrossRefPubMed
25.
go back to reference Avendano M, Kunst AE, van Lenthe F, Bos V, Costa G, Valkonen T, Cardano M, Harding S, Borgan JK, Glickman M, Reid A, Mackenbach JP: Trends in socioeconomic disparities in stroke mortality in six european countries between 1981–1985 and 1991–1995. Am J Epidemiol. 2005, 161: 52-61. 10.1093/aje/kwi011.CrossRefPubMed Avendano M, Kunst AE, van Lenthe F, Bos V, Costa G, Valkonen T, Cardano M, Harding S, Borgan JK, Glickman M, Reid A, Mackenbach JP: Trends in socioeconomic disparities in stroke mortality in six european countries between 1981–1985 and 1991–1995. Am J Epidemiol. 2005, 161: 52-61. 10.1093/aje/kwi011.CrossRefPubMed
26.
go back to reference Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Lowik MR: Socio-economic status, dietary intake and 10y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr. 2003, 57: 128-137. 10.1038/sj.ejcn.1601503.CrossRefPubMed Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Lowik MR: Socio-economic status, dietary intake and 10y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr. 2003, 57: 128-137. 10.1038/sj.ejcn.1601503.CrossRefPubMed
27.
go back to reference Wardle J, Griffith J: Socioeconomic status and weight control practices in British adults. J Epidemiol Community Health. 2001, 55: 185-90. 10.1136/jech.55.3.185.CrossRefPubMedPubMedCentral Wardle J, Griffith J: Socioeconomic status and weight control practices in British adults. J Epidemiol Community Health. 2001, 55: 185-90. 10.1136/jech.55.3.185.CrossRefPubMedPubMedCentral
28.
go back to reference Popkin BM: The nutrition transition and obesity in the developing world. J Nutr. 2001, 131 (3): 871S-873S.PubMed Popkin BM: The nutrition transition and obesity in the developing world. J Nutr. 2001, 131 (3): 871S-873S.PubMed
29.
go back to reference Florentino RF, Villavieja GM, Lana RD: Dietary and physical activity patterns of 8- to 10- year-old urban schoolchildren in Manila, Philippines. Food Nutr Bull. 2002, 23: 267-73.CrossRefPubMed Florentino RF, Villavieja GM, Lana RD: Dietary and physical activity patterns of 8- to 10- year-old urban schoolchildren in Manila, Philippines. Food Nutr Bull. 2002, 23: 267-73.CrossRefPubMed
30.
go back to reference Hu G, Pekkarinen H, Hanninen O, Tian H, Jin R: Comparison of dietary and non-dietary risk factors in overweight and normal-weight Chinese adults. Br J Nutr. 2002, 88: 91-7. 10.1079/BJN2002590.CrossRefPubMed Hu G, Pekkarinen H, Hanninen O, Tian H, Jin R: Comparison of dietary and non-dietary risk factors in overweight and normal-weight Chinese adults. Br J Nutr. 2002, 88: 91-7. 10.1079/BJN2002590.CrossRefPubMed
31.
go back to reference Kosulwat V: The nutrition and health transition in Thailand. Public Health Nutr. 2002, 5: 183-9. 10.1079/PHN2001292.CrossRefPubMed Kosulwat V: The nutrition and health transition in Thailand. Public Health Nutr. 2002, 5: 183-9. 10.1079/PHN2001292.CrossRefPubMed
32.
go back to reference Wang WJ, Wang KA, Li TL, Xiang HD, Ma LM, Fu ZY, Chen JS, Liu ZY, Bai J, Feng JG, Jin SX, Li YQ, Qin RL, Chen H: Obesity epidemic patterns of Chinese adults: prevalence survey of overweight and obesity. Chin J Epidemiol. 2001, 22: 129-132. Wang WJ, Wang KA, Li TL, Xiang HD, Ma LM, Fu ZY, Chen JS, Liu ZY, Bai J, Feng JG, Jin SX, Li YQ, Qin RL, Chen H: Obesity epidemic patterns of Chinese adults: prevalence survey of overweight and obesity. Chin J Epidemiol. 2001, 22: 129-132.
33.
go back to reference He J, Klag MJ, Wu ZL, Whelton PK: Stroke in the People's Republic of China I. Geographic Variations in Incidence and Risk Factors. He J, Klag MJ, Wu ZL, Whelton PK: Stroke in the People's Republic of China I. Geographic Variations in Incidence and Risk Factors.
34.
go back to reference O'Mahony PG, Dobson R, Rodgers H, James OF, Thomson RG: Validation of a population screening questionnaire to assess prevalence of stroke. Stroke. 1995, 26: 1334-1337.CrossRefPubMed O'Mahony PG, Dobson R, Rodgers H, James OF, Thomson RG: Validation of a population screening questionnaire to assess prevalence of stroke. Stroke. 1995, 26: 1334-1337.CrossRefPubMed
35.
go back to reference Wu GX, Wu ZS, He BL: Epidemiological characteristics of stroke in 16 provinces of China. Chin Med J. 1994, 74: 281-283. Wu GX, Wu ZS, He BL: Epidemiological characteristics of stroke in 16 provinces of China. Chin Med J. 1994, 74: 281-283.
36.
go back to reference Li LM, Rao KQ, Kong LZ, Yao CH, Xiang HD, Zhai FY, Ma GS, Yang XG: A description on the Chinese national nutrition and health survey in 2002. Chin J Epidemiol. 2005, 26: 478-484. Li LM, Rao KQ, Kong LZ, Yao CH, Xiang HD, Zhai FY, Ma GS, Yang XG: A description on the Chinese national nutrition and health survey in 2002. Chin J Epidemiol. 2005, 26: 478-484.
Metadata
Title
Impact of socio-economic factors on stroke prevalence among urban and rural residents in Mainland China
Authors
Fei Xu
Lap Ah Tse
XiaoMei Yin
Ignatius Tak-sun Yu
Sian Griffiths
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2008
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-8-170

Other articles of this Issue 1/2008

BMC Public Health 1/2008 Go to the issue