From the Institute of Atherosclerosis Research (K.B., H.S., G.A.), the
Institute of Epidemiology and Social Medicine (K.B.), and the Department of
Neurology (K.B., F.S.), University of Muenster, Muenster, Germany.
Correspondence to Klaus Berger, MD, MPH, MSc, Institute of Epidemiology and Social Medicine, Muenster University, Domagkstr 3, 48129 Muenster, Germany. E-mail bergerk{at}uni-muenster.de
Background and Purpose—The purpose
of this study was to assess the incidence of stroke and the magnitude
of classic stroke risk factors in an occupational cohort of
white-collar and blue-collar workers.
Methods—We studied a prospective cohort of 12 866 male
employees, aged 30 to 65 years, in 52 companies in northwestern
Germany, with an average follow-up of 7.2 years. Participants were free
of self-reported stroke, transient ischemic attack, and
myocardial infarction at baseline. Physical examination, blood tests,
and a face-to-face interview to assess presence of various risk factors
were performed at the workplace. Follow-up was done by standardized
mailed questionnaire. Main outcome measure was first stroke
occurrence.
Results—Overall stroke incidence was 42.4 per 100 000
person-years, increasing from 10.1 per 100 000 person-years in the age
category 30 to 39 years to 33.6, 80.6, and 159.2 per 100 000
person-years in the age categories 40 to 49, 50 to 59, and 60 years and
older, respectively. After adjustment for potential confounders, the
relative risks of total stroke associated with systolic blood
pressure
Conclusions—This occupational cohort had a 2-fold lower stroke
incidence than that observed in cohorts of the general population. In
the absence of a strong healthy-worker effect, moderate differences in
behavioral risk factors and a higher treatment rate for hypertension
contribute to the explanation of this favorable stroke incidence.
© 1998 American Heart Association, Inc.
Original Contributions
Incidence and Risk Factors for Stroke in an Occupational Cohort
The PROCAM Study
120, 121 to 140, and 
141 mm Hg were 1.00
(reference), 2.99 (95% confidence interval, 0.85 to 10.49), and 5.56
(1.56 to 19.88). The risks associated with smoking status of
never/past, 20 cigarettes per day, and >20 cigarettes per day) were
1.00 (reference), 1.65 (0.62 to 4.42), and 3.56 (1.78 to 7.15),
respectively. A history of hypertension at baseline (yes versus no) was
independently associated with a relative risk of 2.37 (1.20 to 4.71)
for total stroke and a history of diabetes mellitus (yes versus no)
with a risk of 2.21 (1.00 to 4.87). A comparison of risk factor levels
with a general population study revealed only small differences.
Key Words: cerebrovascular disorders • epidemiology • incidence • occupation • risk factors • stroke
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