Income level is associated with differences in primary and secondary stroke prevention in China

Huiming Ren; Junrong Ma; Xu Guo; Ruijie Zhang; Liyuan Pu; Tian Zhao; Fangfang Zeng; Chang Shu; Liyuan Han; Yunzhi Wang; Qiang Li; Xiaojie Wang

doi:10.5114/aoms/178269

Income level is associated with differences in primary and secondary stroke prevention in China

Arch Med Sci. 2024 Oct 28;20(5):1472-1483. doi: 10.5114/aoms/178269. eCollection 2024.

Authors

Huiming Ren¹, Junrong Ma², Xu Guo¹, Ruijie Zhang^{1

3}, Liyuan Pu^{1

3}, Tian Zhao^{1

3}, Fangfang Zeng², Chang Shu⁴, Liyuan Han^{1

3}, Yunzhi Wang⁵, Qiang Li^{3

6}, Xiaojie Wang⁷

Affiliations

¹ Department of Rehabilitation Medicine, Ningbo No. 2 Hospital, Ningbo, China.
² Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou City, Guangdong Province, China.
³ Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo City, Zhejiang Province, China.
⁴ Tianjin Cerebral Vascular and Neural Degenerative Disease Key Laboratory, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China.
⁵ University of Sydney School of Health Sciences, Australia.
⁶ Department of Neurosurgery, Ningbo No. 2 Hospital, University of Chinese Academy of Sciences, Ningbo City, Zhejiang Province, China.
⁷ Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen City, Guangdong Province, China.

Abstract

Introduction: The aim of this study was to assess differences in the effects of income level on the primary and secondary prevention of stroke in the Chinese population.

Material and methods: This was a population-based study using data from a China Kadoorie Biobank survey that began in 2004 in 10 geographical regions. Community residents (n = 512,715) aged 30-79 years were recruited. Stroke was determined by the self-reporting of a doctor's diagnosis, and participants with a high risk of stroke were identified using the model developed in the Prediction for ASCVD Risk in China study.

Results: The final numbers of people included in this study were 8,884 with stroke and 218,972 with a high risk of stroke. The participants' income level was positively associated with high levels of physical activity and the consumption of a healthy diet, but negatively associated with the control of alcohol consumption (all p < 0.05). In addition, positive associations were observed between the control of smoking and the use of antiplatelet and antihypertensive medication for primary prevention (all p < 0.05), but there was a negative association with the control of blood pressure (p < 0.001).

Conclusions: Low-income individuals were less likely to control smoking and their diet and use preventive medications, while high-income individuals were less likely to control their alcohol consumption and blood pressure. Moreover, medication use was low for both primary and secondary prevention in high-income individuals.

Keywords: China Kadoorie Biobank; differences; income level; prevention; stroke.

Grants and funding

Funding This work is supported by National Natural Science Foundation of China (82173648), Medical Scientific Research Foundation of Zhejiang Province, China (2021RC028); Zhejiang Provincial Public Service and Application Research Foundation, China (LGC22H260005); Key Program of Ningbo Natural Science Foundation, China (2022J271); Zhu Xiu Shan Talent Project of Ningbo No. 2 Hospital, Project Number: 2023HMJQ-19; Ningbo Leading Top Talent Training Project (2022RC-LJ-01); Internal Fund of Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences (2020YJY0212); HwaMei Research Foundation of Ningbo No. 2 Hospital, Grant No. 2023HMZD01 and 2022HMKY12; Medical Scientific Research Foundation of Zhejiang Province, China (2022RC253); Ningbo Health Technology Project, No: 2022Y30; Ningbo Natural Science Foundation (2022J275); Ningbo Key Research and Development Plan Project (2023Z173); Ningbo Clinical Research Center for Medical Imaging (No. 2021L003), Provincial and Municipal Co-construction Key Discipline for Medical Imaging (2022-S02), Project of NINGBO Leading Medica l& Health Discipline (2022-B12); the Public Welfare Foundation of Ningbo (2021S108); Shenzhen Nanshan District Science and Technology Bureau (2020075); Shenzhen science and technology project (JCYJ20210324125810024); Natural Science Foundation of Guangdong Province (2022A1515011273), and Ningbo Key Support Medical Discipline (Grant No. 2022-F22). Additional fund: Ningbo Key SupporNingbo Key Support Medical Discipline (2022-F22), China; Zhejiang Medical Health Science and Technology Project (2022ZH048); Ningbo Youth Technical Core Personnel Talent Project (2023RC-QN-12); Huamei Hospital Fund (2021HMKY60); Nanshan Science and Technology Bureau Project, Shenzhen (NSZD2024052) and Ningbo Public Welfare Project (2021S146).