There is a strong inverse relationship between socioeconomic status and stroke incidence and mortality both between and within populations worldwide.1 In a recent meta-analysis of 17 studies, a low socioeconomic status was associated with a 1.67 times increased risk of stroke (95% confidence interval [CI] 1.46-1.91).2 Differences in the prevalence and severity of vascular risk factors may partly, but not completely, explain such increased stroke risk among lower socioeconomic groups. [1][2][3][4][5] Most likely, there is a cumulative effect of negative socioeconomically driven influences during different life stages. Within such a life-course perspective, there is evidence that socioeconomic conditions during childhood may play an independent and important role regarding stroke risk in later life. Geographic associations between childhood mortality in the early 20th century and later stroke mortality and associations between birth weight and cardiovascular diseases point to infantile conditions being risk factors for stroke and cardiovascular diseases.6-8 Several but not all cohort 6,9-15 and case-control studies [16][17][18] described an inverse relationship between childhood conditions and risk of stroke that was independent of adulthood socioeconomic conditions. However, the understanding of the role of the socioeconomic status during different life stages as stroke risk factor remains incomplete. We performed a case-control study to investigate socioeconomic, genetic, and infectious risk factors for stroke and their interdependence. Here, we report on the hypothesis that adverse socioeconomic conditions in childhood, adolescence, and adulthood each independently contribute to the risk of first-ever ischemic stroke. We particularly focused on living conditions, parental status, and other elements of childhood socioeconomic conditions and assessed their role regarding the risk of adulthood ischemic stroke.
MethodsWithin the target population of individuals aged 18 to 80 years living in the city of Ludwigshafen a.Rh. in South-West Germany, the Background and Purpose-The association between socioeconomic status in adulthood and the risk of stroke is well established; however, the independent effects of socioeconomic conditions in different life phases are less understood. Methods-Within a population-based stroke registry, we performed a case-control study with 470 ischemic stroke patients (cases) aged 18 to 80 years and 809 age-and sex-matched stroke-free controls, randomly selected from the population (study period October 2007 to April 2012). We assessed socioeconomic conditions in childhood, adolescence, and adulthood, and developed a socioeconomic risk score for each life period. Results-Socioeconomic conditions were less favorable in cases regarding paternal profession, living conditions and estimated family income in childhood, school degree, and vocational training in adolescence, last profession, marital status and periods of unemployment in adulthood.
Inclusion and Exclusion CriteriaInclusion criteria ...