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- Title
Neighborhood socioeconomic status and the prevalence of stroke and coronary heart disease in rural China: A population-based study.
- Authors
Tang, Xun; Laskowitz, Daniel T.; He, Liu; Østbye, Truls; Bettger, Janet Prvu; Cao, Yang; Li, Na; Li, Jingrong; Zhang, Zongxin; Liu, Jianjiang; Yu, Liping; Xu, Haitao; Hu, Yonghua; Goldstein, Larry B.
- Abstract
Background Lower neighborhood-level socioeconomic status ( SES) is associated with an increased risk of vascular disease in developed countries. Aims This study aims to identify village- and individual-level determinants of stroke and coronary heart disease ( CHD) in a rural Chinese population. Methods We analyzed data from a population-based survey of 14 424 rural Chinese adults aged over 40 years from 54 villages. Primary outcomes were stroke and coronary heart disease ( CHD) prevalence. Village-level SES was determined from the Chinese government's official statistical yearbook. Individual-level characteristics were obtained by in-person interviews. Prevalence rate ratios ( RRs) and 95% confidence intervals (95% CIs) were calculated using generalized linear mixed models with log-link function to explore associations of village-level SES and individual social, demographic, and cardiovascular risk factors with stroke or CHD. Variance was expressed using the median rate ratio ( MRR) and interval rate ratio ( IRR). Results Village accounted for significant variability in the prevalence of stroke ( MRR = 1·70; 95% CI: 1·42-1·94; P < 0·05) and CHD ( MRR = 1·59; 95% CI: 1·35-1·78, P < 0·05), with village-level income alone accounting for 10% and 13·5% of between-village variation in stroke and CHD, respectively. High-income villages were at higher risk of both stroke ( RR = 1·69, 95% CI: 1·09-2·62) and CHD ( RR = 1·63, 95% CI: 1·13-2·34) than lower-income villages. Among individual-level risk factors, hypertension was associated with a higher prevalence of stroke ( RR = 2·33, 95% CI: 1·93-2·80) than CHD ( RR = 1·58, 95% CI: 1·38-1·82), whereas obesity was only associated with CHD ( RR = 1·43, 95% CI: 1·23-1·66). In addition, there was an interaction between age and income; residents of higher-income villages below age 60 had a higher prevalence of CHD ( RR = 1·58, 95% CI: 1·15-2·18) but not stroke. Conclusions There were differences in vascular risk across rural villages in China, with higher lifetime stroke and CHD prevalence in higher-income villages. For CHD, neighborhood effects were stronger among younger residents of high-income villages. The results may have implications for public health interventions targeting populations at risk.
- Subjects
CHINA; SOCIAL status; DISEASE prevalence; STROKE; CORONARY disease; VASCULAR diseases; DEVELOPED countries
- Publication
International Journal of Stroke, 2015, Vol 10, Issue 3, p388
- ISSN
1747-4930
- Publication type
Article
- DOI
10.1111/ijs.12343