Do Vascular Risk Factors Explain the Association between Socioeconomic Status and Stroke Incidence: A Meta-Analysis

Kerr, Gillian D.; Slavin, Helen; Clark, Donna M.; Coupar, Fiona; Langhorne, Peter; Stott, David J.

doi:10.1159/000320855

Cited by 80 publications

(95 citation statements)

References 45 publications

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“…In a metaanalysis, when compared to the highest socioeconomic category, the HR for the lowest was 1.67 (95% CI 1.46-1.91). When adjusting for classical risk factors (such as hypertension, smoking, diabetes, obesity, alcohol, and physical activity), the HR decreased to 1.31 (95% CI 1.16-1.48) (15). In the present study, socioeconomic confounding was reduced by restricting the cohort to skilled and unskilled manual workers.…”

Section: Sjögren Et Alcontrasting

confidence: 51%

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Occupational exposure to particles and incidence of stroke

Sjögren¹,

Lönn²,

Fremling³

et al. 2012

Scand J Work Environ Health

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Objectives This paper aims to investigate the relation between occupational exposure to particles, particle size, and the incidence of ischemic and hemorrhagic stroke. MethodsThe cohort included all manual workers identified from the Swedish National Census in 1980, who were alive as of 1 January 1987. First time events of ischemic or hemorrhagic stroke during the period 1987-2005 were identified through linkage to the Hospital Discharge Register and the National Cause of Death Register. A job-exposure matrix for exposure to small (<1 µm) and large (>1 µm) particles was developed and applied. Hazard ratios (HR) were estimated by Cox regression with adjustment for age, socioeconomic group, and residential area.Results Increased HR of ischemic stroke were found among both women and men occupationally exposed to small as well as large particles for ≥5 years. The risks were higher for workers exposed for ≥5 years compared to "ever exposed" participants indicating a dose-response relationship, but no trend with exposure intensity was observed. A tentative association between particle exposure and hemorrhagic stroke was also found.Conclusions Occupational exposure to small and large particles was associated with increased risks of ischemic stroke. Further studies are needed to explore the relationships between exposure to different types of particles and various doses and the occurrence of stroke among women as well as men.

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Section: Sjögren Et Alcontrasting

confidence: 51%

“…Among both women and men, socioeconomic status is related to stroke (15,16). In a metaanalysis, when compared to the highest socioeconomic category, the HR for the lowest was 1.67 (95% CI 1.46-1.91).…”

Section: Sjögren Et Almentioning

confidence: 98%

Occupational exposure to particles and incidence of stroke

Sjögren¹,

Lönn²,

Fremling³

et al. 2012

Scand J Work Environ Health

View full text Add to dashboard Cite

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“…2 In a previous study from our group 18 which motivated the present investigation, stroke risk factors, and particularly behavioral risk factors, had a strong attenuating effect on the role of socioeconomic determinants. A lifetime social score was not independently associated with stroke risk.…”

Section: Discussionmentioning

confidence: 81%

“…[1][2][3][4][5] Most likely, there is a cumulative effect of negative socioeconomically driven influences during different life stages. Within such a life-course perspective, there is evidence that socioeconomic conditions during childhood may play an independent and important role regarding stroke risk in later life.…”

mentioning

confidence: 99%

“…1 In a recent meta-analysis of 17 studies, a low socioeconomic status was associated with a 1.67 times increased risk of stroke (95% confidence interval [CI] 1.46-1.91). 2 Differences in the prevalence and severity of vascular risk factors may partly, but not completely, explain such increased stroke risk among lower socioeconomic groups. [1][2][3][4][5] Most likely, there is a cumulative effect of negative socioeconomically driven influences during different life stages.…”

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confidence: 99%

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Socioeconomic Conditions in Childhood, Adolescence, and Adulthood and the Risk of Ischemic Stroke

Becher

Palm

Aigner

et al. 2016

Stroke

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There is a strong inverse relationship between socioeconomic status and stroke incidence and mortality both between and within populations worldwide.1 In a recent meta-analysis of 17 studies, a low socioeconomic status was associated with a 1.67 times increased risk of stroke (95% confidence interval [CI] 1.46-1.91).2 Differences in the prevalence and severity of vascular risk factors may partly, but not completely, explain such increased stroke risk among lower socioeconomic groups. [1][2][3][4][5] Most likely, there is a cumulative effect of negative socioeconomically driven influences during different life stages. Within such a life-course perspective, there is evidence that socioeconomic conditions during childhood may play an independent and important role regarding stroke risk in later life. Geographic associations between childhood mortality in the early 20th century and later stroke mortality and associations between birth weight and cardiovascular diseases point to infantile conditions being risk factors for stroke and cardiovascular diseases.6-8 Several but not all cohort 6,9-15 and case-control studies [16][17][18] described an inverse relationship between childhood conditions and risk of stroke that was independent of adulthood socioeconomic conditions. However, the understanding of the role of the socioeconomic status during different life stages as stroke risk factor remains incomplete. We performed a case-control study to investigate socioeconomic, genetic, and infectious risk factors for stroke and their interdependence. Here, we report on the hypothesis that adverse socioeconomic conditions in childhood, adolescence, and adulthood each independently contribute to the risk of first-ever ischemic stroke. We particularly focused on living conditions, parental status, and other elements of childhood socioeconomic conditions and assessed their role regarding the risk of adulthood ischemic stroke. MethodsWithin the target population of individuals aged 18 to 80 years living in the city of Ludwigshafen a.Rh. in South-West Germany, the Background and Purpose-The association between socioeconomic status in adulthood and the risk of stroke is well established; however, the independent effects of socioeconomic conditions in different life phases are less understood. Methods-Within a population-based stroke registry, we performed a case-control study with 470 ischemic stroke patients (cases) aged 18 to 80 years and 809 age-and sex-matched stroke-free controls, randomly selected from the population (study period October 2007 to April 2012). We assessed socioeconomic conditions in childhood, adolescence, and adulthood, and developed a socioeconomic risk score for each life period. Results-Socioeconomic conditions were less favorable in cases regarding paternal profession, living conditions and estimated family income in childhood, school degree, and vocational training in adolescence, last profession, marital status and periods of unemployment in adulthood. Inclusion and Exclusion CriteriaInclusion criteria ...

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Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States

2022

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IMPORTANCE Stroke centers are associated with better outcomes. There is substantial literature surrounding disparities in stroke outcomes for underserved populations. However, the existing literature has focused primarily on discrimination at the individual or institutional level, and studies of structural discrimination in stroke care are scant.OBJECTIVE To examine differences in hospitals' likelihood of adopting stroke care certification between historically underserved and general communities. DESIGN, SETTING, AND PARTICIPANTSThis study combined a data set of hospital stroke certification from all general acute nonfederal hospitals in the continental US from January 1, 2009, to December 31, 2019, with national, hospital, and census data to define historically underserved communities by racial and ethnic composition, income distribution, and rurality. For all categories except rurality, communities were categorized by the composition and degree of segregation of each characteristic. Cox proportional hazard models were then estimated to compare the hazard of adopting stroke care certification between historically underserved and general communities, adjusting for population size and hospital bed capacity. Data were analyzed from June 2021 to April 2022. MAIN OUTCOMES AND MEASURES Hospitals' likelihood of adopting stroke care certification.RESULTS A total of 4984 hospitals were included. From 2009 to 2019, the total number of hospitals with stroke certification grew from 961 to 1763. Hospitals serving Black, racially segregated communities had the highest hazard of adopting stroke care certification (hazard ratio [HR], 1.67; 95% CI, 1.41-1.97) in models not accounting for population size, but their hazard was 26% lower than among those serving non-Black, racially segregated communities (HR, 0.74; 95% CI, 0.62-0.89) in models controlling for population and hospital size. Adoption hazard was lower in low-income communities compared with high-income communities, regardless of their level of economic segregation, and rural hospitals were much less likely to adopt any level of stroke care certification relative to urban hospitals (HR, 0.43; 95% CI, 0.35-0.51). CONCLUSIONS AND RELEVANCEIn this analysis of stroke certification adoption across acute care hospitals in the US from 2009 to 2019, hospitals in low-income and rural communities had a lower likelihood of receiving stroke certification than hospitals in general communities. Hospitals operating in Black, racially segregated communities had the highest likelihood of adopting stroke care, but because these communities had the largest population, patients in these communities had the lowest likelihood of access to stroke-certified hospitals when the model controlled for population size. These findings provide empirical evidence that the provision of acute neurological services is structurally inequitable across historically underserved communities.

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Do Vascular Risk Factors Explain the Association between Socioeconomic Status and Stroke Incidence: A Meta-Analysis

Cited by 80 publications

References 45 publications

Occupational exposure to particles and incidence of stroke

Occupational exposure to particles and incidence of stroke

Socioeconomic Conditions in Childhood, Adolescence, and Adulthood and the Risk of Ischemic Stroke

Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States

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