Centre for Health Equity Studies, Stockholm University/Karolinska Institute, Stockholm, Sweden.
Scand J Public Health. 2011 Dec;39(8):797-804. doi: 10.1177/1403494811418280. Epub 2011 Sep 5.
This study explored the association between income and stroke mortality in the total working population in Sweden and examined whether the associations differ by gender or for stroke subtypes intracerebral haemorrhage (ICH) or brain infarction (BI).
This was a register-based study among nearly 3 million working women and men (30-64 years in 1990) with a 12-year follow up (1991-2002) for mortality from stroke (4886 deaths). Income was measured as annual registered income from work in 1990. Gender-specific Cox regressions were applied with adjustments for sociodemographic covariates.
The age-adjusted hazard ratio (95% confidence interval) of lowest versus highest income quartile was 1.80 (1.48-2.19) for any stroke, 1.68 (1.29-2.17) for ICH and 2.23 (1.53-3.22) for BI in women, and the corresponding figures for men were 2.12 (1.92-2.34), 2.02 (1.77-2.31), and 2.09 (1.77-2.46). Adjustment for covariates attenuated these associations to 1.69 (1.33-2.15) for any stroke and 1.56 (1.14-2.14) for ICH in women and to 1.98 (1.74-2.24) for any stroke and 1.77 (1.44-2.19) for BI in men. In contrast, adjustment for covariates amplified the estimates to 2.36 (1.52-3.66) for BI in women and to 2.05 (1.73-2.44) for ICH in men.
Risk of stroke mortality was highest in the lowest income group, with a gradient for the intermediate groups, in both women and men. The risk of mortality from BI was highest in women with the lowest income and the risk of ICH was highest in men with the lowest income.
本研究旨在探讨瑞典全部劳动人口的收入与卒中死亡率之间的关联，并检验这些关联是否因性别或卒中亚型（脑出血 [ICH] 或脑梗死 [BI]）而有所不同。
这是一项在近 300 万 30-64 岁的劳动妇女和男性中开展的基于登记的研究，随访时间为 12 年（1991-2002 年），以观察卒中死亡情况（4886 例死亡）。1990 年的年收入作为工作收入的年度登记收入进行测量。采用性别特异性 Cox 回归模型，调整社会人口学协变量。
在女性中，校正年龄后的最低与最高四分位收入组的全因卒中风险比（95%置信区间）分别为 1.80（1.48-2.19）、1.68（1.29-2.17）和 2.23（1.53-3.22），男性则分别为 2.12（1.92-2.34）、2.02（1.77-2.31）和 2.09（1.77-2.46）。调整协变量后，这些关联在女性中分别减弱至 1.69（1.33-2.15）和 1.56（1.14-2.14），在男性中则减弱至 1.98（1.74-2.24）和 1.77（1.44-2.19）。相比之下，调整协变量后，女性的 BI 风险增加至 2.36（1.52-3.66），男性的 ICH 风险增加至 2.05（1.73-2.44）。
在女性和男性中，最低收入组的卒中死亡率最高，中间收入组的风险呈梯度升高。女性中最低收入组的 BI 死亡率最高，男性中最低收入组的 ICH 死亡率最高。
