Association of socioeconomic status with incidence and mortality of heart disease and stroke in older people in China
AffiliationFaculty of Education, Health and Wellbeing
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AbstractIntroduction: Over the past four decades, China has experienced increasing gap between the rich and poor, along with rapid economic development, and increased the numbers of heart disease and stroke. The population in Chins is ageing. It is unclear whether socioeconomic inequalities are associated with increased risk of heart disease and stroke in older people and their surviving in China. This PhD study aimed to investigate the associations of multiple measurements of socioeconomic status (SES) with incidence of heart disease and stroke in older Chinese people and all-cause mortality in those patients. Methods: Two prospective community-based cohort studies were conducted in Anhui province and in four other provinces in China. The Anhui cohort consisted of a random sample of 3,336 older adults, of whom 1,736 aged ≥65 years recruited from urban areas in 2001 and 1,600 aged ≥60 years from rural areas in 2003. In a standard questionnaire interview, they were recorded for sociodemographic, behaviours/lifestyles, social networks and supports, cardiovascular diseases and other related risk factors. SES was measured by urban-rural living, educational level, occupational class, satisfactory income, and any serious financial problems occurred in the past two years. Heart disease and stroke were documented based on self-reported doctor-diagnosis. The cohort members were followed up until 2011 to monitor vital status and causes of mortality, during which three waves of re-interviews were taken for survivors to further document incident heart disease and stroke. Following the same protocol as that in the last two surveys in the Anhui cohort study, the Four-province cohort study completed a baseline survey in 2008-2009 for 4,314 participants who were aged ≥60 years, who were randomly recruited from Guangdong, Shanghai, Heilongjiang, and Shanxi. The Four-province cohort study was followed up until 2012 to monitor the vital status and with re-interviewing survivors. The data of the Anhui cohort and the Four-province cohort studies were analysed in multivariate Cox regression models to examine the associations of SES with incidence and mortality of heart disease and stroke, respectively. Results: The data from the two cohort studies showed that low SES was generally associated with increased incidence of heart disease and stroke and all-cause mortality in older adults with these diseases, although the association varied with SES indicators. Pooled data demonstrated that while rural versus urban living was associated with reduced incidence of heart disease (multivariate adjusted hazard ratio 0.56, 95% CI 0.44-0.71), it increased mortality in participants with heart disease (3.57, 2.01-6.34). Rural living was associated with increased incidence of stroke (1.66, 1.08-2.57) and non-significantly all-cause mortality in participants with stroke (1.98, 0.70-5.59). While high occupational class was associated with increased incidence of stroke (1.56, 1.01-2.38), low level of education was significantly associated with mortality in participants with heart disease (1.59, 1.05-2.39). Low income or having financial problems was associated with increased incidence of heart disease (1.42, 1.00-2.00 in low family income) and all-cause mortality in people with heart disease (2.68, 1.08-6.65 in low personal income). Conclusions: In China older people with low SES had increased risks of heart disease (except for rural living) and stroke (except for occupational class). Impact of low SES on increased mortality in older people with heart disease and stroke appeared stronger. Strategies targeting different SES groups involving comprehensive approaches are needed to reduce incidence of heart disease and stroke and improve surviving in older people with heart disease and stroke.
PublisherUniversity of Wolverhampton
TypeThesis or dissertation
DescriptionA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.
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