title: Association between infectious burden, socioeconomic status, and ischemic stroke.
abstract: Infectious diseases contribute to stroke risk, and are associated with socioeconomic status (SES). We tested the hypotheses that the aggregate burden of infections increases the risk of ischemic stroke (IS) and partly explains the association between low SES and ischemic stroke.
  
  
  
  In a case-control study with 470 ischemic stroke patients and 809 age- and sex-matched controls, randomly selected from the population, antibodies against the periodontal microbial agents Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, against Chlamydia pneumonia, Mycoplasma pneumoniae (IgA and IgG), and CagA-positive Helicobacter pylori (IgG) were assessed.
  
  
  
  IgA seropositivity to two microbial agents was significantly associated with IS after adjustment for SES (OR 1.45 95% CI 1.01-2.08), but not in the fully adjusted model (OR 1.32 95% CI 0.86-2.02). By trend, cumulative IgA seropositivity was associated with stroke due to large vessel disease (LVD) after full adjustment (OR 1.88, 95% CI 0.96-3.69). Disadvantageous childhood SES was associated with higher cumulative seropositivity in univariable analyses, however, its strong impact on stroke risk was not influenced by seroepidemiological data in the multivariable model. The strong association between adulthood SES and stroke was rendered nonsignificant when factors of dental care were adjusted for.
  
  
  
  Infectious burden assessed with five microbial agents did not independently contribute to ischemic stroke consistently, but may contribute to stroke due to LVD. High infectious burden may not explain the association between childhood SES and stroke risk. Lifestyle factors that include dental negligence may contribute to the association between disadvantageous adulthood SES and stroke.
authors.affiliation: Department of Neurology, Klinikum Ludwigshafen, Germany. Electronic address: palmf@klilu.de.
authors.forename: Frederick
authors.initials: F
authors.lastname: Palm
authors.affiliation: Oral and Maxillofacial Diseases, University of Helsinki, Finland.
authors.forename: Pirkko J
authors.initials: PJ
authors.lastname: Pussinen
authors.affiliation: Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Aigner
authors.affiliation: Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany; Institute of Public Health, University of Heidelberg, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Becher
authors.affiliation: Department of Neurology, Klinikum Ludwigshafen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Buggle
authors.affiliation: Clinical Chemistry, Klinikum Ludwigshafen, Germany.
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Bauer
authors.affiliation: Department of Neurology, University of Heidelberg, Germany.
authors.forename: Caspar
authors.initials: C
authors.lastname: Grond-Ginsbach
authors.affiliation: Institute of Public Health, University of Heidelberg, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Safer
authors.affiliation: Department of Neurology, Klinikum Ludwigshafen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Urbanek
authors.affiliation: Department of Neurology, Klinikum Ludwigshafen, Germany.
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Grau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000276:immunology; D001419:Bacteria / Q000302:isolation & purification; D002545:Brain Ischemia / Q000150:complications* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D007239:Infections / Q000150:complications*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000150:complications* / Q000473:pathology; D055815:Young Adult
chemical_list: D000906:Antibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G
keywords: Infection; Ischemic stroke; Large vessel disease; Periodontitis; Socioeconomic status