Childhood and Adult Social Conditions and Risk of Stroke

Abstract

Background: Socioeconomic conditions may strongly influence the risk of stroke. We tested the hypotheses that indexes of social status in different life periods including childhood are inversely associated with stroke risk and that there is a cumulative effect of social conditions during lifetime on the risk of stroke. Furthermore, we investigated whether social advancement compared to the parental generation is associated with reduced stroke risk. Methods: In a case-control study, we assessed parental professional status, highest school degree, professional education and the last professional activity in 370 consecutive patients with ischemic or hemorrhagic stroke or transient ischemic attack [TIA; age 60.7 ± 12.8 years (mean ± standard deviation); 31.1% women] and 370 age- and sex-matched control subjects randomly selected from the general population of the same area. Results: Higher level of school exams [odds ratio (OR) 0.58, 95% confidence interval (CI) 0.39–0.86], university or polytechnic high school degrees (OR 0.39, 95% CI 0.24–0.63), nonmanual (last or current) professional activity (OR 0.51, 95% CI 0.37–0.71) and father’s nonmanual professional activity (OR 0.64, 95% 0.43–0.97) were associated with a lower risk of stroke/TIA. Adjustment for vascular risk factors including current smoking and alcohol consumption reduced the strength of these associations and rendered them nonsignificant except for university or polytechnic high school degrees (OR 0.49, 95% CI 0.27–0.87). Additional adjustment for regular sports activity further attenuated the association between academic degrees and risk of stroke/TIA (OR 0.56, 95% CI 0.31–1.02). A score summarizing 4 lifetime social indexes was not independently associated with stroke risk (OR 0.67, 95% CI 0.39–1.16). Social advancement as assessed by changes from paternal manual work to nonmanual work in the index generation was more common among control subjects (23.5%) than patients (15.3%; p = 0.0097), but such advancement was not independently associated with stroke/TIA after adjustment for all covariables (OR 0.82, 95% CI 0.50–1.33). Conclusions: Socioeconomic conditions were inversely linked to the risk of stroke/TIA. These associations were strongly influenced by lifestyle factors such as smoking, alcohol consumption and mainly sports activity. Stroke preventive strategies may have a particularly large potential if they focus on such lifestyle habits in socially disadvantaged groups.

Socioeconomic Conditions in Childhood, Adolescence, and Adulthood and the Risk of Ischemic Stroke

“…2 In a previous study from our group 18 which motivated the present investigation, stroke risk factors, and particularly behavioral risk factors, had a strong attenuating effect on the role of socioeconomic determinants. A lifetime social score was not independently associated with stroke risk.…”

“…During adolescence and adulthood, school education, vocational training, last professional activity, frequency of unemployment, and marital status were all less favorable in cases than in controls. Previous studies had mostly assessed one or few of these factors [6][7][8][9][10][11][12][13][14][15][16][17][18] but not the multitude of different aspects as analyzed here. Our observations support the hypothesis that socioeconomic disadvantages during sequential life stages may be linked to stroke risk by a multitude of different influential factors, independent of known risk factors.…”

“…Within such a life-course perspective, there is evidence that socioeconomic conditions during childhood may play an independent and important role regarding stroke risk in later life. Geographic associations between childhood mortality in the early 20th century and later stroke mortality and associations between birth weight and cardiovascular diseases point to infantile conditions being risk factors for stroke and cardiovascular diseases.6-8 Several but not all cohort 6,9-15 and case-control studies [16][17][18] described an inverse relationship between childhood conditions and risk of stroke that was independent of adulthood socioeconomic conditions. However, the understanding of the role of the socioeconomic status during different life stages as stroke risk factor remains incomplete.…”

“…6-8 Several but not all cohort 6,9-15 and case-control studies [16][17][18] described an inverse relationship between childhood conditions and risk of stroke that was independent of adulthood socioeconomic conditions. However, the understanding of the role of the socioeconomic status during different life stages as stroke risk factor remains incomplete.…”

Periodontitis as a risk factor of stroke: a review of literature

“…Atherosclerosis, stroke and periodontitis possess common risk factors: age, male gender, cigarette smoking, diabetes and obesity (Tab. 1) [15,34,35,36,37,38,39]. So far, studies have allowed us to conclude that inflammation existing in the periodontium can lead to the development of atherosclerosis, both directly and indirectly.…”