Changes in the living arrangement and risk of stroke in Japan; does it matter who lives in the household? Who among the family matters?

Abstract

Previous studies have suggested associations of family composition with morbidity and mortality; however, the evidence of associations with risk of stroke is limited. We sought to examine the impact of changes in the household composition on risk of stroke and its types in Japanese population. Cox proportional hazard modelling was used to assess the risk of incident stroke and stroke types within a cohort of 77,001 Japanese men and women aged 45–74 years who experienced addition and/or loss of family members [spouse, child(ren), parent(s) and others] to their households over a five years interval (between 1990–1993 and 1995–1998). During 1,043,446 person-years of the follow-up for 35,247 men and 41,758 women, a total of 3,858 cases of incident stroke (1485 hemorrhagic and 2373 ischemic) were documented. When compared with a stable family composition, losing at least one family member was associated with 11–15% increased risk of stroke in women and men; hazard ratios (95% confidence interval) were 1.11 (1.01–1.22) and 1.15 (1.05–1.26), respectively. The increased risk was associated with the loss of a spouse, and was evident for ischemic stroke in men and hemorrhagic stroke in women. The addition of any family members to the household was not associated with risk of stroke in men, whereas the addition of a parent (s) to the household was associated with increased risk in women: 1.49 (1.09–2.28). When the loss of a spouse was accompanied by the addition of other family members to the household, the increased risk of stroke disappeared in men: 1.18 (0.85–1.63), but exacerbated in women: 1.58 (1.19–2.10). In conclusion, men who have lost family members, specifically a spouse have higher risk of ischemic stroke, and women who gained family members; specifically a parent (s) had the higher risk of hemorrhagic stroke than those with a stable family composition.

A Scoping Review of the Association of Social Disadvantage and Cerebrovascular Disease Confirmed by Neuroimaging and Neuropathology

“…Our final review included 20 articles investigating the impact of social disadvantage on cerebrovascular disease outcomes confirmed by brain imaging or autopsy [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] ( Table 1 ). The majority of the identified studies were published in the past decade ( n = 11) [ 20 , 22 , 25 , 26 , 29 , 30 , 31 , 33 , 35 , 36 , 38 ], indicating growing interest in this kind of work.…”

“…Our final review included 20 articles investigating the impact of social disadvantage on cerebrovascular disease outcomes confirmed by brain imaging or autopsy [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] ( Table 1 ). The majority of the identified studies were published in the past decade ( n = 11) [ 20 , 22 , 25 , 26 , 29 , 30 , 31 , 33 , 35 , 36 , 38 ], indicating growing interest in this kind of work. Nine of the included studies used a study sample based in the United States [ 20 , 21 , 23 , 24 , 27 , 32 , 34 , 36 , 38 ]; five were based in Europe, sampling from the United Kingdom [ 19 , 29 , 37 ], France [ 26 ], and Finland [ 31 ]; four were based in Asia, sampling from Japan [ 25 ], Taiwan [ 28 ], Singapore [ 35 ], and Siberia, Russia [ 22 ]; one used an Australian study population […”

“…The majority of the identified studies were published in the past decade ( n = 11) [ 20 , 22 , 25 , 26 , 29 , 30 , 31 , 33 , 35 , 36 , 38 ], indicating growing interest in this kind of work. Nine of the included studies used a study sample based in the United States [ 20 , 21 , 23 , 24 , 27 , 32 , 34 , 36 , 38 ]; five were based in Europe, sampling from the United Kingdom [ 19 , 29 , 37 ], France [ 26 ], and Finland [ 31 ]; four were based in Asia, sampling from Japan [ 25 ], Taiwan [ 28 ], Singapore [ 35 ], and Siberia, Russia [ 22 ]; one used an Australian study population [ 30 ]; and one included subjects from both the US and Mexico [ 33 ]. More than half of the studies ( n = 11) drew their data from a prospective cohort study or stroke registry [ 19 , 20 , 25 , 26 , 29 , 31 , 33 , 35 , 36 , 37 , 38 ], five used other cross-sectional observational designs [ 22 , 27 , 28 , 32 , 34 ], and the remaining used retrospective medical record reviews in their analysis [ 21 ,…”

The association between objective measures of residence and worksite neighborhood environment, and self-reported leisure-time physical activities: The Aichi Workers' Cohort Study

“…This is the first report to examine walkability in a sample of workers whose residential location is more geographically dispersed than those in community-based samples. The present study is also unique in terms of the urban-suburban setting, as epidemiologic studies are often conducted in rural settings in Japan ( Eshak et al, 2017 ; Soma et al, 2017 ). One previous study in Japan did not find any significant associations between residential neighborhood GIS-measured walkability and leisure-time physical activity (walking and exercise combined) in women, but identified a marginal relationship in men ( Hanibuchi et al, 2015b ).…”

“…To date, a limited number of studies have been carried out in Asian countries utilizing objectively measured environment information ( Hanibuchi et al, 2015b ; Kondo et al, 2009 ; Koohsari et al, 2017 ; Lee et al, 2011 ; Ying et al, 2015 ). In addition, the majority of previous studies in Japan have been conducted on the inhabitants of small cities ( Kondo et al, 2009 ; Lee et al, 2011 ), especially in rural areas ( Eshak et al, 2017 ), which are defined by administrative borders that do not necessarily reflect residential functions.…”