American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

Background and Purpose-This study assesses the effect of socioeconomic status on stroke incidence in the elderly, and the contribution of risk factors to stroke disparities. Methods-Data comprised a sample of 2812 men and women aged 65 years and over from the New Haven cohort of the Established Populations for the Epidemiologic Studies of the Elderly. Individuals provided baseline information on demographics, functioning, cardiovascular and psychosocial risk factors in 1982 and were followed for 12 years. Proportional hazard models were used to model survival from initial interview to first fatal or nonfatal stroke. Results-Two hundred and seventy subjects developed incident stroke. At ages 65 to 74, lower socioeconomic status was associated with higher stroke incidence for both education (HR lowest/highest ϭ2.07, 95% CI, 1.04 to 4.13) and income (HR lowest/highest ϭ2.08, 95% CI, 1.01 to 4.27). Adjustment for race, diabetes, depression, social networks and functioning attenuated hazard ratios to a nonsignificant level, whereas other risk factors did not change associations significantly. Beyond age 75, however, stroke rates were higher among those with the highest education (HR lowest/highest ϭ0.42, 95% CI, 0.22 to 0.79) and income (HR lowest/highest ϭ0.43, 95% CI, 0.22 to 0.86), which remained largely unchanged after adjustment for risk factors. Conclusions-We observed substantial socioeconomic disparities in stroke at ages 65 to 74, whereas a crossover of the association occurred beyond age 75. Policies to improve social and economic resources at early old age, and interventions to improve diabetes management, depression, social networks and functioning in the disadvantaged elderly can contribute to reduce stroke disparities.

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We use cross-national, longitudinal data to explore the impact of educational level on changes in health outcomes among Europeans aged over 50. Our analyses are performed separately for Northern, Western and Southern Europe, as these regions broadly represent different welfare state regimes. We find that low education is associated with higher incident events -over a two-year period -of poor health, chronic diseases and disability, but it is less consistently associated with new events of long-standing illness. Net of behavioural risk factors, educational effects are more consistent in Western and Southern Europe than in the Nordic welfare states. In Northern Europe, lower education is associated with less financial and employment disadvantage than in Southern or Western Europe. After controlling for educational differences in these factors, effects of educational level on health deterioration remain significant for most outcomes in Western and Southern Europe, whereas they are weaker and non-significant after adjustment in Northern Europe.