Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies

Marco M. Ferrario (Lead / Corresponding author), Giovanni Veronesi, Frank Kee, Lloyd E. Chambless, Kari Kuulasmaa, Torben Jørgensen, Philippe Amouyel, Dominique Arveiler, Martin Bobak, Giancarlo Cesana, Wojciech Drygas, Jean Ferrieres, Simona Giampaoli, Licia Iacoviello, Yuri Nikitin, Andrzej Pajak, Annette Peters, Veikko Salomaa, Stefan Soderberg, Abdonas TamosiunasTom Wilsgaard, Hugh Tunstall-Pedoe, on behalf of the MORGAM Project

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Abstract

Background: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.

Materials and Methods: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.

Results: Compared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86-413 and 78-156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%-130% and 40%-89% of the average incidence rates. Inequalities in risk factors accounted for 45%-70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.

Conclusions: Social inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.

Original languageEnglish
Pages (from-to)1210-1216
Number of pages8
JournalJournal of Epidemiology and Community Health
Volume71
Issue number12
Early online date5 Oct 2017
DOIs
Publication statusPublished - 7 Nov 2017

Fingerprint

Cohort Studies
Stroke
Incidence
Lithuania
Scandinavian and Nordic Countries
Vulnerable Populations
Population Characteristics
Body Mass Index
Cardiovascular Diseases
Smoking
Alcohols
Population

Keywords

  • stroke
  • social inequalities
  • social epidemiology
  • cohort studies

Cite this

Ferrario, M. M., Veronesi, G., Kee, F., Chambless, L. E., Kuulasmaa, K., Jørgensen, T., ... on behalf of the MORGAM Project (2017). Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies. Journal of Epidemiology and Community Health, 71(12), 1210-1216. https://doi.org/10.1136/jech-2017-209728
Ferrario, Marco M. ; Veronesi, Giovanni ; Kee, Frank ; Chambless, Lloyd E. ; Kuulasmaa, Kari ; Jørgensen, Torben ; Amouyel, Philippe ; Arveiler, Dominique ; Bobak, Martin ; Cesana, Giancarlo ; Drygas, Wojciech ; Ferrieres, Jean ; Giampaoli, Simona ; Iacoviello, Licia ; Nikitin, Yuri ; Pajak, Andrzej ; Peters, Annette ; Salomaa, Veikko ; Soderberg, Stefan ; Tamosiunas, Abdonas ; Wilsgaard, Tom ; Tunstall-Pedoe, Hugh ; on behalf of the MORGAM Project. / Determinants of social inequalities in stroke incidence across Europe : a collaborative analysis of 126 635 individuals from 48 cohort studies. In: Journal of Epidemiology and Community Health. 2017 ; Vol. 71, No. 12. pp. 1210-1216.
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abstract = "Background: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.Materials and Methods: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.Results: Compared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95{\%} CI 1.25 to 1.91) and 1.41 (95{\%} CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86-413 and 78-156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47{\%}-130{\%} and 40{\%}-89{\%} of the average incidence rates. Inequalities in risk factors accounted for 45{\%}-70{\%} of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17{\%} in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.Conclusions: Social inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.",
keywords = "stroke, social inequalities, social epidemiology, cohort studies",
author = "Ferrario, {Marco M.} and Giovanni Veronesi and Frank Kee and Chambless, {Lloyd E.} and Kari Kuulasmaa and Torben J{\o}rgensen and Philippe Amouyel and Dominique Arveiler and Martin Bobak and Giancarlo Cesana and Wojciech Drygas and Jean Ferrieres and Simona Giampaoli and Licia Iacoviello and Yuri Nikitin and Andrzej Pajak and Annette Peters and Veikko Salomaa and Stefan Soderberg and Abdonas Tamosiunas and Tom Wilsgaard and Hugh Tunstall-Pedoe and {on behalf of the MORGAM Project}",
note = "This work was supported by the MORGAM Project’s recent funding: European Community FP 7 projects CHANCES (HEALTH-F3-2010-242244) and BiomarCaRE (HEALTH-F2-2011-278913). These grants supported central coordination, workshops and part of the activities of the MORGAM Data Centre, at THL in Helsinki, Finland. MORGAM participating centres are funded by regional and national governments, research councils, charities and other local sources.",
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Ferrario, MM, Veronesi, G, Kee, F, Chambless, LE, Kuulasmaa, K, Jørgensen, T, Amouyel, P, Arveiler, D, Bobak, M, Cesana, G, Drygas, W, Ferrieres, J, Giampaoli, S, Iacoviello, L, Nikitin, Y, Pajak, A, Peters, A, Salomaa, V, Soderberg, S, Tamosiunas, A, Wilsgaard, T, Tunstall-Pedoe, H & on behalf of the MORGAM Project 2017, 'Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies', Journal of Epidemiology and Community Health, vol. 71, no. 12, pp. 1210-1216. https://doi.org/10.1136/jech-2017-209728

Determinants of social inequalities in stroke incidence across Europe : a collaborative analysis of 126 635 individuals from 48 cohort studies. / Ferrario, Marco M. (Lead / Corresponding author); Veronesi, Giovanni; Kee, Frank; Chambless, Lloyd E.; Kuulasmaa, Kari; Jørgensen, Torben; Amouyel, Philippe; Arveiler, Dominique; Bobak, Martin; Cesana, Giancarlo; Drygas, Wojciech; Ferrieres, Jean; Giampaoli, Simona; Iacoviello, Licia; Nikitin, Yuri; Pajak, Andrzej; Peters, Annette; Salomaa, Veikko; Soderberg, Stefan; Tamosiunas, Abdonas; Wilsgaard, Tom; Tunstall-Pedoe, Hugh; on behalf of the MORGAM Project.

In: Journal of Epidemiology and Community Health, Vol. 71, No. 12, 07.11.2017, p. 1210-1216.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Determinants of social inequalities in stroke incidence across Europe

T2 - a collaborative analysis of 126 635 individuals from 48 cohort studies

AU - Ferrario, Marco M.

AU - Veronesi, Giovanni

AU - Kee, Frank

AU - Chambless, Lloyd E.

AU - Kuulasmaa, Kari

AU - Jørgensen, Torben

AU - Amouyel, Philippe

AU - Arveiler, Dominique

AU - Bobak, Martin

AU - Cesana, Giancarlo

AU - Drygas, Wojciech

AU - Ferrieres, Jean

AU - Giampaoli, Simona

AU - Iacoviello, Licia

AU - Nikitin, Yuri

AU - Pajak, Andrzej

AU - Peters, Annette

AU - Salomaa, Veikko

AU - Soderberg, Stefan

AU - Tamosiunas, Abdonas

AU - Wilsgaard, Tom

AU - Tunstall-Pedoe, Hugh

AU - on behalf of the MORGAM Project

N1 - This work was supported by the MORGAM Project’s recent funding: European Community FP 7 projects CHANCES (HEALTH-F3-2010-242244) and BiomarCaRE (HEALTH-F2-2011-278913). These grants supported central coordination, workshops and part of the activities of the MORGAM Data Centre, at THL in Helsinki, Finland. MORGAM participating centres are funded by regional and national governments, research councils, charities and other local sources.

PY - 2017/11/7

Y1 - 2017/11/7

N2 - Background: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.Materials and Methods: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.Results: Compared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86-413 and 78-156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%-130% and 40%-89% of the average incidence rates. Inequalities in risk factors accounted for 45%-70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.Conclusions: Social inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.

AB - Background: Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.Materials and Methods: The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.Results: Compared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86-413 and 78-156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%-130% and 40%-89% of the average incidence rates. Inequalities in risk factors accounted for 45%-70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.Conclusions: Social inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.

KW - stroke

KW - social inequalities

KW - social epidemiology

KW - cohort studies

U2 - 10.1136/jech-2017-209728

DO - 10.1136/jech-2017-209728

M3 - Article

C2 - 28983063

VL - 71

SP - 1210

EP - 1216

JO - Journal of Epidemiology and Community Health

JF - Journal of Epidemiology and Community Health

SN - 0143-005X

IS - 12

ER -