Relationship between socioeconomic status and stroke: An observational and network Mendelian randomization study

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-22 DOI:10.1016/j.jstrokecerebrovasdis.2024.108097

Ruijie Zhang , Liyuan Han , Shan Xu , Guozhi Jiang , Liyuan Pu , Huina Liu

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引用次数: 0

Abstract

Background

The relationship between socioeconomic status (SES) and stroke remains controversial, and the underlying mediator is unclear. This study aimed to assess the causal relationship of SES with stroke and its subtypes and to identify potential modifiable risk factors responsible for this relationship.

Methods

The study included 372,437 participants from the UK Biobank. Over an average period of 12.13 years, 6,457 individuals (2.7 %) were recorded as having experienced a stroke. Cox proportional hazards model was used to determine the relationship between SES (average annual household income before tax and age at the end of full-time education) and stroke, ischemic stroke, and hemorrhagic stroke. Two-sample Mendelian randomization (MR) was employed to assess the causal relationship between SES and stroke and its subtypes. Furthermore, network MR was utilized to evaluate the potential mediating role of modifiable risk factors for stroke in this causal relationship.

Results

After adjusting for factors such as sociodemographic characteristics, health behaviors, health status, and past medical history, participants in the second highest income group showed the lowest risk of stroke, with a hazard ratio (HR) of 0.780 (95 % confidence interval [CI]: 0.702–0.866), and for ischemic stroke, the HR was 0.701 (95 % CI: 0.618–0.795). Those who completed full-time education at the latest age group(>18 years) had the lowest risk of stroke (HR: 0.906, 95 % CI: 0.830–0.988) and ischemic stroke (HR: 0.897, 95% CI: 0.811–0.992). MR analysis showed that higher income and education were both associated with a lower risk of stroke (income: inverse-variance-weighted odds ratio [OR_IVW] =0.796, 95 % CI: 0.675–0.940, education: OR_IVW = 0.631, 95 % CI: 0.557–0.716) and ischemic stroke (income: OR_IVW = 0.813, 95 % CI: 0.684–0.966, education: OR_IVW = 0.641, 95 % CI: 0.559–0.735). Additionally, hypertension had the highest mediating effect on this relationship. It accounted for 57.12 % of the effect of income on stroke, 51.24 % on ischemic stroke, and 27 % and 24 % for education.

Conclusion

Higher SES was associated with a lower risk of stroke and ischemic stroke, and hypertension had the highest mediating effect on this causal relationship. The results have significant public health implications, emphasizing the importance of early intervention to reduce the risk of stroke in low SES populations.

查看原文本刊更多论文

社会经济地位与中风之间的关系：一项观察性和网络孟德尔随机研究。

背景：社会经济地位（SES）与脑卒中之间的关系仍存在争议，潜在的中介因素尚不清楚。本研究旨在评估社会经济地位与中风及其亚型之间的因果关系，并确定导致这种关系的潜在可调节风险因素：研究对象包括英国生物库中的 372437 名参与者。在平均 12.13 年的时间里，有 6,457 人（2.7%）被记录为中风患者。采用 Cox 比例危险模型确定 SES（税前家庭年平均收入和全日制教育结束时的年龄）与中风、缺血性中风和出血性中风之间的关系。采用双样本孟德尔随机法（MR）评估 SES 与中风及其亚型之间的因果关系。此外，还利用网络 MR 评估了可改变的中风风险因素在这一因果关系中的潜在中介作用：结果：在对社会人口学特征、健康行为、健康状况和既往病史等因素进行调整后，第二高收入组的参与者中风风险最低，危险比（HR）为 0.780（95% 置信区间 [CI]：0.702-0.866），缺血性中风的危险比为 0.701（95% 置信区间：0.618-0.795）。在最晚年龄组（大于 18 岁）完成全日制教育者发生脑卒中（HR：0.906，95% CI：0.830-0.988）和缺血性脑卒中（HR：0.897，95% CI：0.811-0.992）的风险最低。MR 分析显示，收入和教育程度越高，中风风险越低（收入：逆方差加权几率比 [ORIVW] =0.796，95% CI：0.675-0.940，教育程度：ORIVW = 0.631）：ORIVW = 0.631，95% CI：0.557-0.716）和缺血性中风（收入：收入：ORIVW = 0.813，95% CI：0.684-0.966，教育程度：ORIVW = 0.641，95% CI：0.557-0.716ORIVW = 0.641，95% CI：0.559-0.735）。此外，高血压对这一关系的中介效应最大。它占收入对中风影响的 57.12%，占缺血性中风影响的 51.24%，占教育影响的 27% 和 24%：结论：较高的社会经济地位与较低的中风和缺血性中风风险相关，而高血压对这一因果关系的中介效应最大。这些结果对公共卫生具有重要意义，强调了早期干预对降低低社会经济地位人群中风风险的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.