Pennlert Johanna, Asplund Kjell, Glader Eva-Lotta, Norrving Bo, Eriksson Marie
From the Department of Public Health and Clinical Medicine, Medicine, (J.P., K.A., E.-L.G.), and Department of Statistics, Umeå School of Business and Economics (M.E.), Umeå University, Sweden; and Department of Medical Sciences, Section of Neurology, Lund University, Sweden (B.N.).
Stroke. 2017 Jun;48(6):1518-1523. doi: 10.1161/STROKEAHA.116.015643. Epub 2017 May 2.
This nationwide observational study aimed to investigate how socioeconomic status is associated with risk of stroke recurrence and how possible associations change over time.
This study included 168 295 patients, previously independent in activities of daily living, with a first-ever stroke in the Swedish Stroke Register (Riksstroke) 2001 to 2012. Riksstroke was linked with Statistics Sweden as to add individual information on education and income. Subdistribution hazard regression was used to analyze time from 28 days after first stroke to stroke recurrence, accounting for the competing risk of other causes of death.
Median time of follow-up was 3.0 years. During follow-up, 23 560 patients had a first recurrent stroke, and 53 867 died from other causes. The estimated cumulative incidence of stroke recurrence was 5.3% at 1 year, and 14.3% at 5 years. Corresponding incidence for other deaths were 10.3% and 30.2%. Higher education and income were associated with a reduced risk of stroke recurrence. After adjusting for confounding variables, university versus primary school education returned a hazard ratio of 0.902; 95% confidence interval, 0.864 to 0.942, and the highest versus the lowest income tertile a hazard ratio of 0.955; 95% confidence interval, 0.922 to 0.989. The risk of stroke recurrence decreased during the study period, but the inverse effect of socioeconomic status on risk of recurrence did not change significantly.
Despite a declining risk of stroke recurrence over time, the differences in recurrence risk between different socioeconomic groups remained at a similar level in Sweden during 2001 to 2012.
这项全国性观察性研究旨在调查社会经济地位如何与卒中复发风险相关联，以及这种可能的关联如何随时间变化。
本研究纳入了168295例既往日常生活能够自理的患者，这些患者于2001年至2012年在瑞典卒中登记处（Riksstroke）首次发生卒中。Riksstroke与瑞典统计局相关联，以添加有关教育和收入的个人信息。采用亚分布风险回归分析首次卒中后28天至卒中复发的时间，并考虑其他死因的竞争风险。
中位随访时间为3.0年。随访期间，23560例患者首次复发卒中，53867例死于其他原因。卒中复发的估计累积发生率在1年时为5.3%，在5年时为14.3%。其他死亡的相应发生率分别为10.3%和30.2%。高等教育和高收入与卒中复发风险降低相关。在对混杂变量进行调整后，大学教育与小学教育相比，风险比为0.902；95%置信区间为0.864至0.942，收入最高三分位数与最低三分位数相比，风险比为0.955；95%置信区间为0.922至0.989。在研究期间，卒中复发风险降低，但社会经济地位对复发风险的反向影响没有显著变化。
尽管随着时间推移卒中复发风险下降，但在2001年至2012年期间，瑞典不同社会经济群体之间的复发风险差异仍保持在相似水平。
