title: Socioeconomic status inconsistency and risk of stroke among Japanese middle-aged women.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social and Environmental Health, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Graduate School of Medicine, University of Tokyo, Toyko, Japan (M.I.); and Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Kaori
authors.initials: K
authors.lastname: Honjo
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social and Environmental Health, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Graduate School of Medicine, University of Tokyo, Toyko, Japan (M.I.); and Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.). iso@pbhel.med.osaka-u.ac.jp.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social and Environmental Health, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Graduate School of Medicine, University of Tokyo, Toyko, Japan (M.I.); and Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social and Environmental Health, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Graduate School of Medicine, University of Tokyo, Toyko, Japan (M.I.); and Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Norie
authors.initials: N
authors.lastname: Sawada
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social and Environmental Health, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Graduate School of Medicine, University of Tokyo, Toyko, Japan (M.I.); and Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
mesh_terms: D000328:Adult; D044466:Asian People; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D009790:Occupations; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*
keywords: Japan; education; female; occupations; social class; stroke