248026 Social-Biological Differences Across the Lifespan and Risk of Stroke Incidence: A Life Course Epidemiology Analysis

Sunday, October 30, 2011

Longjian Liu, MD, PhD, MSc, FAHA , Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
Fuzhong Xue, MD, MPH, PhD , Epidemiology and Biostatistics, Shandong University School of Public Health, Jinan, China
Jixiang Ma, PhD , Shandong Center for Disease Control and Prevention, Institute of Non-Communicable Disease Prevention, Jinan, Shandong, China
Marshal Ma, MD, MPH , Bureau of Epidemiology, Pennsylvania Department of Health, Harrisburg, PA
Craig J. Newschaffer, PhD, MS , Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
Objectives: We aimed to examine the complex association of social-biological differences across the lifespan with risk of stroke incidence using a nationally representative study sample.

Methods: Participants aged >=50 years (n=24,064), recruited between 1992 and 2008 in the Health Retirement Study, were followed on average 9.7 years. Stroke incidence was defined as self-report of a physician-diagnosis of first stroke. Socioeconomic status (SES) in childhood was assessed using parents' education level. Social-biological status in adulthood was assessed by subjects' education level, body mass index (BMI), and chronic non-communicable disease. Associations between social-biological factors and stroke incidence were examined prospectively using multivariate Cox's regression models.

Results: Within the follow-up period, a total of 2,358 first stroke incidence were diagnosed. African Americans had the highest incidence rate (11.3%), followed by White (9.87%), Hispanic (7.35%), and others (6.62%). Multivariate Cox's models indicated that poor SES in childhood, and poor SES and worse health conditions in adulthood significantly predicted risk of stroke. The hazard ratios (95%CI) of mother's education (<9 yrs), and participants' education (<9 yrs), increased BMI (30 or higher kg/m2), and having hypertension, heart disease and/or diabetes for the risk of stroke were 1.31 (1.19-1.44), 1.44 (1.27-1.64), and 1.54 (1.41-1.68), 1.58(1.42-1.76), 1.48 (1.35-1.62), and 2.01 (1.78-2.27) respectively. Conclusions: The study provides further evidence for the association of poor SES and health conditions in early life with risk of stroke in later life. This finding highlights that prevention initiatives across the lifespan may lead to a substantial risk reduction of stroke incidence in later life.

Learning Areas:
Public health biology
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. to understand the possible pathway by which early living experience may influence risk of disease in later life. 2. to discuss life course epidemiology approach in data analysis and public health practice.

Keywords: Health Disparities, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I created the analytical concept and conducted the analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.