Effectiveness of the Combined Approach for Assessing Social Gradients in Stroke Risk Among Married Women in Japan

BACKGROUND Analysis of the effects of social gradients on women's health requires a suitable means of assessing social standing. METHODS We compared social gradients in stroke risk among 9317 married Japanese women from the Japan Public Health Center-based Prospective Study over a 16-year period. Social gradient was estimated by 3 methods of indicating social position: education level derived by using the individual approach (woman's own educational level), the conventional approach (using her partner's educational level), and the combined approach (combining the woman's and her partner's educational levels). RESULTS As compared with the lowest educational group, stroke risk was similar among women in the highest educational group using the individual approach and lower, but not significantly so, with the conventional approach. With the combined approach, however, the age- and area-adjusted hazard ratio (HR) was significantly lower among the highest education group as compared with the lowest group (HR = 0.52, 95% CI: 0.36, 0.76), and the relative index of inequality was significant (RII = 0.48, 95% CI: 0.32, 0.72). Using the combined approach, the results were similar irrespective of employment status. In the combined highest educational group, stroke risk among unemployed women was significantly reduced by 54%, while stroke risk for employed women was significantly reduced by 46%, as compared with the lowest educational group, with RIIs of 0.42 (95% CI: 0.21, 0.85) and 0.49 (0.30, 0.80), respectively. CONCLUSIONS The results suggest that a combined approach better reflects social standing among married women in Japan.