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. 2015;25(3):254-60.
doi: 10.2188/jea.JE20140117.

Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan

Kaori Honjo  1 , Hiroyasu Iso, Tomoki Nakaya, Tomoya Hanibuchi, Ai Ikeda, Manami Inoue, Norie Sawada, Shoichiro Tsugane; Japan Public Health Center-based Prospective Study Group
Collaborators, Affiliations

Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan

Kaori Honjo et al. J Epidemiol. 2015.

Abstract
in English, Japanese

Background: Neighborhood deprivation has been shown in many studies to be an influential factor in cardiovascular disease risk. However, no previous studies have examined the effect of neighborhood socioeconomic conditions on the risk of stroke in Asian countries.

Methods: This study investigated whether neighborhood deprivation was associated with the risk of stroke and stroke death using data from the Japan Public Health Center-based Prospective Study. We calculated the adjusted hazard ratios of stroke mortality (mean follow-up, 16.4 years) and stroke incidence (mean follow-up, 15.4 years) according to the area deprivation index (ADI) among 90 843 Japanese men and women aged 40-69 years. A Cox proportional-hazard regression model using a shared frailty model was applied.

Results: The adjusted hazard ratios of stroke incidence, in order of increasing deprivation with reference to the least deprived area, were 1.16 (95% CI, 1.04-1.29), 1.12 (95% CI, 1.00-1.26), 1.18 (95% CI, 1.02-1.35), and 1.19 (95% CI, 1.01-1.41), after adjustment for individual socioeconomic conditions. Behavioral and psychosocial factors attenuated the association, but the association remained significant. The associations were explained by adjusting for biological cardiovascular risk factors. No significant association with stroke mortality was identified.

Conclusions: Our results indicate that the neighborhood deprivation level influences stroke incidence in Japan, suggesting that area socioeconomic conditions could be a potential target for public health intervention to reduce the risk of stroke.

背景—: 居住地域の社会経済状況が循環器疾患リスクと関連があることは主に欧米の先行研究により報告されているが、これまでにアジア地域からの報告はない。

方法—: 本研究は、居住地域の社会経済状況と脳卒中死亡・罹患リスクの関連について日本の大規模コホートのひとつであるJPHCコホート研究のデータを用いて検証することを目的とした。対象者はJPHC研究に参加した40-69歳の地域住民90,843人。居住地域の社会経済状況を示す指標として、国勢調査などの多数の地域統計指標を合成して推定した近隣居住地域剥奪度(Area Deprivation Index: ADI)を5分位に分類し用いた。平均16.4年間の脳卒中死亡および平均15.4年間の罹患を追跡した。マルチレベル生存分析を用い、年齢、性別、職業、保健所地域、近隣居住地域の人口密度を調整したハザード比を算出した。

結果―: 脳卒中罹患リスクにおける居住地域剥奪度の調整ハザード比は、剥奪度最低群（1群：最も裕福）を基準として、1.16 (95%CI, 1.04-1.29) (2群)、1.12 (95%CI, 1.00-1.26) (3群)、1.18 (95%CI, 1.02-1.35) (4群)、1.19 (95%CI, 1.01-1.41) (5群：最も貧しい)であった。脳卒中死亡リスクとの関連は見られなかった。

結論—: 本研究の結果、近隣居住地域の社会経済状況とそこに居住する人の脳卒中罹患リスクが関連することを示した。貧しい地域に居住する人は豊かな地域に居住する人と比較して、脳卒中のリスクが低い傾向がみられ、日本における脳卒中予防において地域の社会経済状況を考慮する必要があることが示唆された。

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