Educational and homeownership inequalities in the incidence of stroke: a longitudinal study of mid-aged women in Australia

Jackson, Caroline A., Jones, Mark and Mishra, Gita D. (2013) Educational and homeownership inequalities in the incidence of stroke: a longitudinal study of mid-aged women in Australia. European Journal of Public Health, Advance Access 2: 1-6. doi:10.1093/eurpub/ckt073

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Author Jackson, Caroline A.
Jones, Mark
Mishra, Gita D.
Title Educational and homeownership inequalities in the incidence of stroke: a longitudinal study of mid-aged women in Australia
Journal name European Journal of Public Health   Check publisher's open access policy
ISSN 1101-1262
Publication date 2013-06-20
Year available 2013
Sub-type Article (original research)
DOI 10.1093/eurpub/ckt073
Open Access Status Not Open Access
Volume Advance Access
Issue 2
Start page 1
End page 6
Total pages 6
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Background: We aimed to determine which socioeconomic status measures are associated with stroke risk in mid-aged women and assess the contribution of lifestyle, biological and psychosocial factors to observed associations.

Methods: We included women born in 1946–51 from the Australian Longitudinal Study on Women’s Health, who were surveyed every 3 years. Using generalized estimating equation analysis, we determined the association between socioeconomic status and stroke at the subsequent survey, adjusting for time-varying covariates. For significant associations, we calculated the contribution of individual mediating factors in explaining these associations.

Results: Among 11 468 women aged 47–52 years, 177 strokes occurred during a 12-year follow-up. Education (odds ratio lowest vs. highest 2.45, 95% confidence interval: 1.40–4.30) and homeownership, but not occupation or managing on income, were significantly associated with stroke. After full adjustment, the overall association between education and stroke was non-significant. Lifestyle (smoking, exercise, alcohol and body mass index), biological (hypertension, diabetes, heart disease and hysterectomy/oophorectomy) and psychosocial (depression and marital status) factors explained 38% of the association in the lowest versus highest education groups. Lifestyle and biological factors together accounted for 34%. Mediators accounted for 29% of the association between homeownership and stroke, with lifestyle and psychosocial factors responsible for most of this attenuation. However, a significant association remained in fully adjusted models (odds ratio non-homeowner vs. homeowner 1.63, 95% confidence interval: 1.12–2.38).

Conclusions: Lower education level is associated with increased stroke risk in mid-aged women, and is partially mediated by known risk factors, particularly lifestyle and biological factors. Non-homeownership is associated with increased stroke risk, but the underlying mechanism is unclear.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: June 20, 2013

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
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Created: Sat, 08 Mar 2014, 01:42:23 EST by Caroline Jackson on behalf of School of Public Health