Occupational class differences in outcomes after ischemic stroke: a prospective observational study

Abstract

Background Occupational class is an integral part of socioeconomic status. The studies focused on the occupational difference in ischemic stroke outcome in a Chinese population are limited. We aimed to investigate the associations between occupational class and the prognosis of patients with ischemic stroke in China. Methods We included 1484 ischemic stroke participants (mean age: 63.42 ± 11.26 years) from the prospective cohort study: Infectious Factors, Inflammatory Markers and Prognosis of Acute Ischemic Stroke (IIPAIS). Occupational class was categorized into white-collar workers, blue-collar workers and farmers in our study. Study outcomes were cardiovascular events and all-cause mortality within 12 months after ischemic stroke onset. We applied Cox proportional hazard model to evaluate the associations between the occupational class and study outcomes after ischemic stroke. Results Within 12 months after ischemic stroke, there were 106 (7.5%) cardiovascular events and 69 (4.9%) all-cause deaths. The Kaplan–Meier plots showed that white-collar workers had highest risk of cardiovascular events after 12-month follow-up (Log-rank P = 0.02). Multivariate adjusted hazard ratio and 95% confidence intervals (CIs) of farmers versus white-collar workers was 0.43(0.20–0.91) for cardiovascular events. No significant difference showed in blue-collar workers versus white-collar workers, with fully adjusted hazard ratio 0.62(95% CIs, 0.23–1.67). Conclusions Compared with white-collar workers, farmers are associated with less risk of cardiovascular events at 12 months after ischemic stroke, while there are no significant differences in blue-collar workers.

The Efficacy of Needle-Warming Moxibustion Combined with Hyperbaric Oxygen Therapy for Ischemic Stroke and Its Effect on Neurological Function

“…[ 4 , 5 ]. According to epidemiological statistics, the prognosis of ischemic stroke is not ideal, with 27% of vascular events occurring within 1 year and 45% within 5 years [ 6 ]. Currently, there is no effective treatment for ischemic stroke, and the conventional treatment schemes include anticoagulation, neuroprotective drugs, and platelet anticoagulation drugs [ 7 – 9 ].…”

Role of cognitive reserve in ischemic stroke prognosis: A systematic review

“…A total of 23 studies (22-24, 26, 28, 29, 32-35, 48) enrolled patients with first-episode ischemic stroke, and five studies (25,27,30,31,44) selected patients with ischemic and hemorrhagic stroke but reported separately. In addition, 16 studies (23, 25, 27, 28, 30, 32, 35-38, 41, 42, 44, 49) defined cognitive reserve indicators as socioeconomic status, eight studies (22,24,29,31,40,43,45,47) used education attainment, two studies (26, 39) measured premorbid IQ, and one study each estimated bilingualism (34) and occupation (48).…”

“…Based on the QUIPS tool, no studies were excluded. In short, five (27,29,31,32,34) out of 28 studies were rated as having a high risk of bias, eight (22,24,26,39,(45)(46)(47)(48) as moderate, and 15 (23, 25, 28, 30, 33, 35-38, 40-44, 49) as low. Overall, the risk of six domains was judged to vary from low to high-risk bias, respectively, in "study participation" (low risk: 60.71%, moderate risk: 32.13%, and high risk: 7.14%), "study attrition" (low risk: 39.29%, moderate risk: 53.57%, and high risk: 7.14%), "prognosis factor measurement" (low risk: 71.43%, moderate risk: 25.00%, and high risk: 3.57%), "outcome measurement" (low risk: 92.86% and moderate risk: 7.14%), "study confounding" (low risk: 71.43%, moderate risk: 25.00%, and high risk: 3.57%), and "statistical analysis and reporting" (low risk: 46.43% and moderate risk: 53.57%) (Figure 2).…”

“…A total of three studies defined education as proxies and that educational history was associated with lower mortality after ischemic stroke through the Cox regression model and Cox proportional hazard model (31,43). One each study regarded income or occupation as CR indicators, and both of them used the Cox proportional hazard model, but the results were different (27,48). The association of lower income with the increase in the risk of stroke mortality was found in the study by Toivanen et al (27).…”

Spatial-temporal analysis of cerebral infarction mortality in Hokkaido, Japan: an ecological study using a conditional autoregressive model

“…A model included the number of expected deaths as an offset term to adjust for the population size of each municipality. Moreover, in terms of municipality-level socioeconomic status variables, this study adopted; the ratio of people who completed college and university studies (%), the proportion of workers in primary industries (%), such as agriculture and fishing, the proportion of workers in secondary industries (%), such as manufacturing and construction, and the proportion of workers in tertiary industries (%), mainly services [14][15][16][17]. However, these socioeconomic values were impact of socioeconomic factors on stroke is a global challenge, and improving access to healthcare may reduce disparities in outcomes.…”