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Cross-level interaction between individual socioeconomic status and regional deprivation on overall survival after onset of ischemic stroke: National health insurance cohort sample data from 2002 to 2013

Authors
 Jaeyong Shin  ;  Young Choi  ;  Seung Woo Kim  ;  Sang Gyu Lee  ;  Eun-Cheol Park 
Citation
 Journal of Epidemiology, Vol.27(8) : 381-388, 2017 
Journal Title
 Journal of Epidemiology 
ISSN
 0917-5040 
Issue Date
2017
MeSH
Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Health Status Disparities* ; Humans ; Japan/epidemiology ; Male ; Middle Aged ; National Health Programs ; Poverty Areas* ; Residence Characteristics/statistics & numerical data* ; Social Class* ; Stroke/mortality* ; Survival Analysis
Keywords
Mortality ; Regional deprivation ; Socioeconomic status ; Stroke
Abstract
INTRODUCTION: The literature on stroke mortality and neighborhood effect is characterized by studies that are often Western society-oriented, with a lack of racial and cultural diversity. We estimated the effect of cross-level interaction between individual and regional socioeconomic status on the survival after onset of ischemic stroke. METHODS: We selected newly diagnosed ischemic stroke patients from 2002 to 2013 using stratified representative sampling data of 1,025,340 subjects. A total of 37,044 patients over the 10 years from 2004 to 2013 had newly diagnosed stroke. We calculated hazard ratios (HR) of 12- and 36-month mortality using the Cox proportional hazard model, with the reference group as stroke patients with high income in advantaged regions. RESULTS: For the middle income level, the patients in advantaged regions showed low HRs for overall mortality (12-month HR 1.27; 95% confidence interval [CI], 1.13-1.44; 36-month HR 1.25; 95% CI, 1.14-1.37) compared to the others in disadvantaged regions (12-month HR 1.36; 95% CI, 1.19-1.56; 36-month HR 1.30; 95% CI, 1.17-1.44). Interestingly, for the low income level, the patients in advantaged regions showed high HRs for overall mortality (12-month HR 1.27; 95% CI, 1.13-1.44; 36-month HR 1.33; 95% CI, 1.22-1.46) compared to the others in disadvantaged regions (12-month HR 1.25; 95% CI, 1.09-1.43; 36-month HR 1.30; 95% CI, 1.18-1.44). CONCLUSION: Although we need to perform further investigations to determine the exact mechanisms, regional deprivation, as well as medical factors, might be associated with survival after onset of ischemic stroke in low-income patients.
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DOI
10.1016/j.je.2016.08.020
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
김승우(Kim, Seung Woo) ORCID logo https://orcid.org/0000-0002-5621-0811
박은철(Park, Eun-Cheol) ORCID logo https://orcid.org/0000-0002-2306-5398
신재용(Shin, Jae Yong)
이상규(Lee, Sang Gyu) ORCID logo https://orcid.org/0000-0003-4847-2421
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160574
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