Response to Letter Regarding Article, “Socioeconomic Status Inconsistency and Risk of Stroke Among Japanese Middle-Aged Women”
In response to the concerns by Dr Liao et al, we conducted our analysis by subtype of stroke. We performed a similar analysis to that in Table 4 in our previous article2 and estimated adjusted hazard ratios (HRs) for subarachnoid hemorrhage, intraparenchymal hemorrhage, and ischemic stroke according to status inconsistency. The adjusted HRs (95% confidence interval) of the overqualified group for subarachnoid hemorrhage, intraparenchymal hemorrhage, and ischemic stroke compared with the qualified group were 1.69 (0.53–5.40), 2.82 (0.92–8.65), and 2.08 (0.84–5.18), respectively. We identified an increased risk of each stroke subtype among overqualified women compared with qualified women, although the differences were not significant because of the small number of stroke subtype cases in the overqualified group. These results did not change the conclusion of our previous article.2
In addition, we recategorized job category into blue-collar (manual) and white-collar (professional/managerial, office, or service/sales) jobs following the Jichi Medical School (JMS) cohort study3 mentioned in the letter and examined the effect of white-collar job with reference to blue-collar job on total and subtypes of stroke. The adjusted HRs (95% confidence interval) for total stroke, subarachnoid hemorrhage, intraparenchymal hemorrhage, and ischemic stroke for white-collar compared with blue-color workers were 1.14 (0.95–1.37), 1.29 (0.92–1.80), 0.83 (0.57–1.22), and 1.24 (0.96–1.60), respectively. Our results indicated a similar trend to the results of the Jichi Medical School (JMS) cohort study, which indicated increased risk of subarachnoid hemorrhage stroke and decreased risk of intraparenchymal hemorrhage stroke among white-collar workers: HR=3.39 (1.34–8.55) and HR=0.33 (0.09–1.14), respectively.3
Drs Liao et al1 pointed out our miscalculation regarding distribution of occupation and education level at baseline in Table 1. We have corrected this. We thank them for their indication.
Kaori Honjo, PhD
Global Collaboration Center
Hiroyasu Iso, MD
Department of Social and Environmental Health
Osaka University Graduate School of Medicine
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- © 2014 American Heart Association, Inc.
- Liao N,
- Huang J,
- Xie Z
- Honjo K,
- Iso H,
- Inoue M,
- Sawada N,
- Tsugane S