Independent and combined effect of income and education attainment on the incidence of stroke events: a large-scale cohort study from rural communities in China

ABSTRACT

Objectives

Few studies have longitudinally evaluated income and education, and their combined effect on incident of stroke in China.

Methods

The present study was based on a cohort with a baseline survey in China. A total of 15,913 participants were finally included. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated to evaluate the association of income, education, and their combination with stroke risk by Cox proportional hazard model.

Results

Lower income and less years of education was significantly associated with an increased risk of total stroke [income: adjusted HR: 1.54 (95% CI: 1.22–1.95); education: adjusted HR: 1.59 (95% CI: 1.11–2.28)]. Notably, the highest risk for total stroke was seen among those with lower income and higher education (adjusted HR: 2.46, 95% CI: 1.36–4.47). Sensitivity analysis by excluding the first year of follow-up showed similar findings with the primary analysis.

Discussion

Lower income and education attainment were associated with an increased risk of stroke in Chinese countrysides. A joint effect of income and education existed on the risk of developing stroke. Special attention should be paid for rural community residents, especially for people with low income levels.

KEYWORDS:

• Income
• education
• stroke
• combined effect
• cohort study

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and material

The data that support the findings of this study are available from the corresponding author upon request.

Consent for publication

Informed consent was obtained from all individual participants included in the study.

Ethics approval

The study was carried out according to the Declaration of Helsinki, and the baseline survey and record linkages with study outcomes were approved the Ethics Committee of Fuwai Cardiovascular Hospital, Beijing, China (number 2012–399).

Geolocation information

My paper’s study area is China.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [Nos. 81973122]