Socioeconomic status inconsistency and risk of stroke among Japanese middle-aged women

Stroke. 2014 Sep;45(9):2592-8. doi: 10.1161/STROKEAHA.114.005238. Epub 2014 Jul 15.


Background and purpose: Little research has been conducted to examine the effect of inconsistencies in socioeconomic status on cardiovascular health. In particular, no studies have been reported in Asian countries, including Japan, which is thought to have high socioeconomic status inconsistency among women.

Methods: We examined the effect of status inconsistency between education level and occupation on stroke risk in a prospective 20-year study of 14 742 middle-aged Japanese women included in the prospective Japan Public Health Center-based (JPHC) Study Cohort I in 1990. Status inconsistency between education level and occupation was determined (qualified, overqualified, and underqualified), and the association with risk of stroke was examined. Cox proportional regression analysis was used to determine hazard ratios, which were adjusted for age, marital status, and geographical area.

Results: Adjusted hazard ratio for stroke in overqualified compared with qualified women was 2.06 (95% confidence interval, 1.13-3.78). Adjusted hazard ratios for stroke among highly educated manual workers and workers in service industry were 3.47 (95% confidence interval, 1.54-7.84) and 3.21 (95% confidence interval, 1.49-6.90), respectively, when compared with highly educated professionals/managers.

Conclusions: High academic qualifications without an appropriate job could be a risk factor for stroke among Japanese women. Our result suggests that status inconsistency could be a potential explanation for the increased stroke risk among highly educated women.

Keywords: Japan; education; female; occupations; social class; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asian People
  • Educational Status
  • Employment
  • Female
  • Humans
  • Incidence
  • Japan / epidemiology
  • Middle Aged
  • Occupations
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Social Class
  • Stroke / diagnosis*
  • Stroke / epidemiology*