Top

BMC Public Health

Published in:

Open Access 01-12-2024 | Research

Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan

Authors: Wen-Yu Lin, Ping-Yi Lin, Wen-Miin Liang, Hsien-Wen Kuo

Published in: BMC Public Health | Issue 1/2024

Abstract

Background/Objective

Limited evidence exists regarding the socioeconomic inequalities in cerebrovascular disease (CBD) mortality at different urbanization levels. Therefore, this study was conducted to assess the socioeconomic inequalities and urbanization levels in township-based CBD mortality in Taiwan.

Methods

Socioeconomic variables, including the percentages of low-income households, individuals with a university education and above, and tax payments, were measured at the township level from 2011 to 2020. Urbanization was also determined by the national survey and divided into seven levels. Age-standardized mortality rate (ASMR) of CBD was calculated using a Geographic Information System (GIS) in 358 townships. The effects of socioeconomic variables and urbanization levels on relative and absolute inequalities in township-based CBD mortality rates were examined.

Results

Significant differences in ASMR of CBD were observed across all socioeconomic status indicators over the years. Higher proportions of low-income households were associated with higher ASMR of CBD. Conversely, there were negative correlations between higher proportions of individuals with a university education and above and tax payments with ASMR of CBD. The regression analysis indicated significant impacts of relative and absolute socioeconomic inequalities on ASMR of CBD. Additionally, a moderation effect of socioeconomic variables and urbanization on CBD mortality rates was observed, with rural areas showing sensitivity to these factors.

Conclusion

Although ASMR of CBD showed significant decreases over time, socioeconomic inequalities in CBD mortality rates persist. Interventions targeting socioeconomic inequalities in health outcomes, especially in rural areas, are needed to address this issue.

Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016. N Engl J Med. 2018;379:2429–37. https://doi.org/10.1056/NEJMoa1804492.CrossRefPubMedPubMedCentral

Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, Fisher M, et al. World Stroke Organization (WSO): global stroke fact sheet 2022. Int J Stroke. 2022;17(1):18–29. https://doi.org/10.1177/17474930211065917.CrossRefPubMed

Tsai CF, Wang YH, Teng NC, Yip PK, Chen LK. Incidence, subtypes, sex differences and trends of stroke in Taiwan. PLoS ONE. 2022;17(11):e0277296. https://doi.org/10.1371/journal.pone.0277296.CrossRefPubMedPubMedCentral

Tu WJ, Zhao Z, Yin P, Cao L, Zeng J, Chen H, Fan D, et al. Estimated Burden of Stroke in China in 2020. JAMA Netw Open. 2023;6(3):e231455.CrossRefPubMedPubMedCentral

Tong S, Siyang C, Ke W, Min S, Xianyan Z, Chao Y. Trends in Incidence and Mortality of Stroke in China from 1990 to 2019. Front Neurol. 2021;12:759221. https://doi.org/10.3389/fneur.2021.759221.CrossRef

Addo J, Ayerbe L, Mohan KM, Crichton S, Sheldenkar A, Chen R, et al. Socioeconomic status and stroke: an updated review. Stroke. 2012;43:1186–91. https://doi.org/10.1161/STROKEAHA.111.639732.CrossRefPubMed

Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468–81. https://doi.org/10.1056/NEJMsa0707519.CrossRefPubMed

Jiang TB, Deng ZW, Zhi YP, Cheng H, Gao Q. The effect of urbanization on Population Health: evidence from China. Front Public Health. 2021;9:706982. https://doi.org/10.3389/fpubh.2021.706982.CrossRefPubMedPubMedCentral

Shin J, Choi Y, Kim SW, Lee SG, Park EC. Cross-level interaction between individual socioeconomic status and regional deprivation on overall survival after onset of ischemic stroke: National health insurance cohort sample data from 2002 to 2013. J Epidemiol. 2017;27(8):381–8. https://doi.org/10.1016/j.je.2016.08.020.CrossRefPubMedPubMedCentral

10.

World Health Organization. Health inequalities. 2024. https://www.who.int/health-topics/health-equity#tab=tab_1. Accessed 24 Jan 2024.

11.

Song L, Lin N. Social capital and health inequality: evidence from Taiwan. J Health Soc Behav. 2009;50(2):149–63. https://doi.org/10.1177/002214650905000203.CrossRefPubMed

12.

Lee Y, Lin RS, Sung FC, Yang C, Chien K, Chen W, Su T, Hsu H, Huang Y. Chin-Shan Community Cardiovascular Cohort in Taiwan-baseline data and five-year follow-up morbidity and mortality. J Clin Epidemiol. 2000;53(8):838–46. https://doi.org/10.1016/s0895-4356(00)00198-0.CrossRefPubMed

13.

Hsu JC, Tseng YC, Chang SM, et al. Health inequality: a longitudinal study on geographic variations in lung cancer incidence and mortality in Taiwan. BMC Public Health. 2020;20:951. https://doi.org/10.1186/s12889-020-09044-2.CrossRefPubMedPubMedCentral

14.

Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44(6):757–71. https://doi.org/10.1016/s0277-9536(96)00073-1.CrossRefPubMed

15.

Sergeant JC, Firth D. Relative index of inequality: definition, estimation, and inference. Biostatistics. 2006;7:213–24. https://doi.org/10.1093/biostatistics/kxj002.CrossRefPubMed

16.

Hu HH, Chu FL, Wong WJ, Lo YK, Sheng WY. Trends in mortality from cerebrovascular disease in Taiwan. Stroke. 1986;17:1121–5. https://doi.org/10.1161/01.str.17.6.1121.CrossRefPubMed

17.

Hsu YY, Wang R, Bai CH. Significant impacts of work-related Cerebrovascular and Cardiovascular diseases among Young workers: a nationwide analysis. Int J Environ Res Public Health. 2019;16:961. https://doi.org/10.3390/ijerph16060961.CrossRefPubMedPubMedCentral

18.

Kivimäki M, Gimeno D, Ferrie JE, Batty GD, Oksanen T, Jokela M, et al. Socioeconomic position, psychosocial work environment and cerebrovascular disease among women: the Finnish public sector study. Int J Epidemiol. 2009;38:1265–71. https://doi.org/10.1093/ije/dyn373.CrossRefPubMedPubMedCentral

19.

Bray BD, Paley L, Hoffman A, James M, Gompertz P, Wolfe CDA, et al. Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England. Lancet Public Health. 2018;3:e185–193. https://doi.org/10.1016/S2468-2667(18)30030-6.CrossRefPubMedPubMedCentral

20.

Manana H, Inmaculada LG, Beatriz PG, Maria TP, Fernando RA, Iñaki G. Social inequalities in cardiovascular mortality in Spain from an intersectional perspective. Rev Esp Cardiol (English Edition). 2020;73:282–9. https://doi.org/10.1016/j.rec.2019.07.022.CrossRef

21.

Jannicke I, Stein EV, Ottar KN, Gerhard S, Marta E, Grethe ST. Educational inequalities in acute myocardial infarction incidence in Norway: a nationwide cohort study. PLoS ONE. 2014;9:e106898. https://doi.org/10.1371/journal.pone.0106898.CrossRef

22.

Enxhela S, Ottar N, Stein EV, Jannicke I, Gerhard S, Marta E, Grace ME, et al. Coronary angiography and myocardial revascularization following the first acute myocardial infarction in Norway during 2001–2009: analyzing time trends and educational inequalities using data from the CVDNOR project. Int J Cardiol. 2016;212:122–8. https://doi.org/10.1016/j.ijcard.2016.03.050.CrossRef

23.

Waenerlund AK, Mosquera PA, Gustafsson PE, San Sebastián M. Trends in educational and income inequalities in cardiovascular morbidity in middle age in Northern Sweden 1993–2010. Scand J Public Health. 2019;47(7):713–21. https://doi.org/10.1177/1403494818790406.CrossRefPubMed

24.

Wehrmeister FC, Wendt AT, Sardinha LMV. Inequalities and chronic non-communicable diseases in Brazil. Epidemiol Serv Saude. 2022;31:e20211065. https://doi.org/10.1590/SS2237-9622202200016.CrossRefPubMedPubMedCentral

25.

Powell-Wiley TM, Baumer Y, Baah FO, Baez AS, Farmer N, Mahlobo CT, et al. Social determinants of Cardiovascular Disease. Circ Res. 2022;130:782–99. https://doi.org/10.1161/CIRCRESAHA.121.319811.CrossRefPubMedPubMedCentral

26.

Lin HC, Lin YJ, Liu TC, Chen CS, Chiu WT. Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey. J Urban Health. 2007;84:604–14. https://doi.org/10.1007/s11524-007-9195-1.CrossRefPubMedPubMedCentral

27.

Lin CJ, Chung CP, Cheng HM, Liu CH, Hsu LC, Chi NF, Tang SC, Taiwan Stroke Society Guidelines Consensus Group, et al. The 2020 Taiwan Stroke Society guidelines for blood pressure control at the acute stage of ischemic stroke. J Formos Med Assoc. 2023;122:98–105. https://doi.org/10.1016/j.jfma.2022.08.010.CrossRefPubMed

28.

Levenson JW, Skerrett PJ, Gaziano JM. Reducing the global burden of cardiovascular disease: the role of risk factors. Prev Cardiol. 2002;5:188–99. https://doi.org/10.1111/j.1520-037x.2002.00564.x.CrossRefPubMed

29.

Lee DS, Chiu M, Manuel DG, Tu K, Wang X, Austin PC, Mattern MY, et al. Canadian Cardiovascular Outcomes Research Team. Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors. CMAJ. 2009;181:E55–66. https://doi.org/10.1503/cmaj.081629.CrossRefPubMedPubMedCentral

30.

Zhang YB, Chen C, Pan XF, Guo J, Li Y, Franco OH, Liu G, Pan A. Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies. BMJ. 2021;373:n604. https://doi.org/10.1136/bmj.n604.CrossRefPubMedPubMedCentral

31.

Gartner A, Farewell D, Roach P, Dunstan F. Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment. Soc Sci Med. 2011;72:1685–94. https://doi.org/10.1016/j.socscimed.2011.03.017.CrossRefPubMed

32.

Casant J, Helbich M. Inequalities of suicide mortality across urban and rural areas: a literature review. Int J Environ Res Public Health. 2022;19(5):2669. https://doi.org/10.3390/ijerph19052669.CrossRefPubMedPubMedCentral

Title: Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan
Authors: Wen-Yu Lin
Ping-Yi Lin
Wen-Miin Liang
Hsien-Wen Kuo
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-18679-4

2024 ASCO Annual Meeting

Springer Medicine

Relative and absolute inequalities in cerebrovascular disease mortality rates: exploring the influence of socioeconomic status and urbanization levels in Taiwan

Abstract

Background/Objective

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background/Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Relationship between religiosity and HPV vaccine initiation and intention in urban black and hispanic parents

Early-life tobacco smoke exposure and stroke risk: a prospective study of 341,783 and 352,737 UK Biobank participants

Walk or be walked by the dog? The attachment role

Correction: Going upstream – an umbrella review of the macroeconomic determinants of health and health inequalities

Knowledge and attitude towards home quarantine instructions and associations with history of Covid-19 infection in Malaysia

Comprehensive knowledge about HIV/AIDS and associated factors among reproductive age women in Liberia