Details of Publication 632 for Project A422:

Jackson C, Jones M & Mishra G. Educational and homeownership inequalities in the incidence of stroke: a longitudinal study of mid-aged women in Australia. , 2013; : 35(S3), 52

Background: Socioeconomic status (SES) is associated with stroke risk, but age and gender differences may exist, underlying mechanisms are unclear and some measures such as homeownership have not been studied. We examined associations between SES and stroke and the contribution of lifestyle, physiological and psychosocial factors to these associations in mid-aged women. Methods: We calculated odds ratios between individual measures of SES and incidentstroke at 4 subsequent surveys using GEE models. Where associations were significant we determinedthe contribution of time-varying covariates, by calculating the percentage attenuationin the coefficient, comparing baseline and adjusted models. Results: Among 11,468 womenborn 1946-51, aged 47-52 years at baseline, 177 incident strokes occurred during 12 yearfollow-up. Education (OR lowest vs highest 2.45, 95% CI 1.40 to 4.30) and homeownership(OR non-homeowner vs homeowner 2.10, 95% CI 1.47 to 2.99), but not occupation or managingon income, were significantly associated with stroke. After full adjustment the associationbetween education and stroke was non-significant. Lifestyle (smoking, exercise, alcohol and BMI), physiological (hypertension, diabetes, heart disease and hysterectomy/oophorectomy)and psychosocial (depression and marital status) factors explained 38% of the association inthe lowest vs highest education groups. Lifestyle and physiological factors explained 25% and17% of the association respectively, together accounting for 34%. Mediators accounted for 29%of the association between homeownership and stroke but a significant association remained in fully adjusted models (OR 1.63, 95% CI 1.12-2.38). Conclusion: Lower education level is associated with increased stroke risk in mid-age women, and is mainly explained by lifestyle and physiological factors. Non-homeownership in these post-war baby boomers is associated with increased stroke risk, but the underlying mechanism requires further research.