Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data

Tetzlaff, Juliane; Geyer, Siegfried; Tetzlaff, Fabian; Epping, Jelena

doi:10.1371/journal.pone.0227541

Cited by 26 publications

(31 citation statements)

References 41 publications

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“…Overall, income inequalities in MI incidence and mortality tend to be higher in men than in women. This finding is in line with results reported in other studies that analysed social inequalities in morbidity and mortality in the German population [ 31 , 50 , 52 , 53 ]. However, some of the differences in the magnitude of inequalities may be attributed to the income measure used in this study.…”

Section: Discussionsupporting

confidence: 93%

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Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies?

et al. 2021

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Background Acute myocardial infarction (MI) remains a frequent health event and a major contributor to long-term impairments globally. So far, research on social inequalities in MI incidence and mortality with respect to MI severity is limited. Furthermore, evidence is lacking on disparities in the length of life affected by MI. This study investigates social inequalities in MI incidence and mortality as well as in life years free of MI and affected by the consequences of mild or severe MI. Methods The study is based on data of a large German statutory health insurance provider covering the years 2008 to 2017 (N = 1,253,083). Income inequalities in MI incidence and mortality risks and in life years with mild or severe MI and without MI were analysed using multistate analyses. The assessment of MI severity is based on diagnosed heart failure causing physical limitations. Results During the study period a total of 39,832 mild MI, 22,844 severe MI, 276,582 deaths without MI, 15,120 deaths after mild MI and 16,495 deaths after severe MI occurred. Clear inequalities were found in MI incidence and mortality, which were strongest among men and in severe MI incidence. Moreover, substantial inequalities were found in life years free of MI in both genders to the disadvantage of those with low incomes and increased life years after mild MI in men with higher incomes. Life years after severe MI were similar across income groups. Conclusions Social inequalities in MI incidence and mortality risks led to clear disparities in the length of life free of MI with men with low incomes being most disadvantaged. Our findings stress the importance of primary and secondary prevention focusing especially on socially disadvantaged groups.

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Section: Discussionsupporting

confidence: 93%

“…Given the high case fatality after a severe MI, this was to be expected. Sharing risk factors and similar pathogenetic processes, substantial income inequalities in life years free of stroke were also found for Germany in elderly women, and even more pronounced in elderly men [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies?

et al. 2021

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“…While it had been shown that the age and sex distribution of the insurance population is comparable to those of the total German population, individuals with low income and lower occupational position are overrepresented [36]. More detailed information on data characteristics can be found in previous studies [37][38][39][40]. The analyses were performed for all individuals aged 20 and older.…”

Section: Datamentioning

confidence: 99%

“…The income information contained in the data is based on the individual annual income reported to the insurer by the employer (working population) or by the Federal Pension Fund (retired population) [37][38][39][40]. Self-employed persons were also included in the analyses, as their insurance contributions also depend on their gross earnings [37][38][39][40].…”

Section: Income Groupsmentioning

confidence: 99%

Socioeconomic inequalities in lung cancer – a time trend analysis with German health insurance data

et al. 2021

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Background Lung Cancer (LC) is one of the most prevalent cancer diseases. Due to the lack of databases which allow the combination of information on individual socioeconomic status (SES) and cancer incidence, research on social inequalities in LC among the German population is rare. The aim of the study is to analyse time trends in social inequalities in LC in Germany. Methods The analyses are based on data of a large statutory health insurance provider. The data contain information on diagnoses, occupation and education (working age), and income (full age range) of the insurance population. Trends were analysed for two subpopulations (retirement age and working age) and stratified by sex. The analyses are based on incidence rates and proportional hazard models spanning the periods 2006–2009, 2010–2013 and 2014–2017. Results Incidence rates declined in men but increased in women. For men, inequalities were strongest in terms of income and the decline in incidence was most pronounced in middle- and higher-income men. Among women at retirement age, a reversed income gradient was found which disappeared in the second period. The educational gradient among the working-age population decreased over time due to the trend towards increasing incidence among individuals with higher education. Declining gradients were also found for occupational position. Conclusion The findings reveal considerable inequalities in LC and that trends vary with respect to SES, sex and age. Widening income inequalities were found in the retired population, while educational and occupational inequalities tend to narrow among the working-age population.

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“…We are talking about the multifactorial higher income which might help but still, other factors may increase the rate of stroke such as genetic factors or having a first or secondgeneration family diagnosed with stroke and in addition to many other factors. Still, there is a controversial finding on the correlation between stroke and the socioeconomic status [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

The Correlation of Matrix Metalloproteinase-9 With Stroke and Prevalence, Risk Factors, and Knowledge of Stroke Among Palestinians

Attili

Hejaz

2020

Innovare J Med Sci

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Objectives: The research study aims to estimate the prevalence of the stroke, to evaluate the stroke associated risk factors, and to determine the factors and symptoms associated with the knowledge of the stroke among the Palestinian population. Furthermore, to find the association between matrix metalloproteinase-9 (MMP-9) levels and the stroke, the concentration of MMP-9 in the serum of stroke patients was measured. Methods: The research study includes a cross-sectional survey that was conducted. The serum MMP-9 levels were also measured in 11 stroke patients using an ELISA reader. Statistical analysis was performed by GraphPad Prism version 8. Sociodemographic characteristics of stroke patients associated with stroke among the Palestinian population were also obtained and analyzed. Results: The higher incidence of the stroke was in the patient’s ages between 51 and 60 years old, with 30 patients (46%) of the total stroke patients. The majority of the stroke patients 40 (60.6%) were having enough income. Most of the stroke patients (29, 43.9%) were none educated. The majority of the stroke patients 48 (72.2%) had a family member/s who has been diagnosed with a stroke. Most of the stroke patients 60 (90.9%) have sudden numbness, weakness in the face, arms, and legs. All the samples analyzed showed a marked increase in MMP-9 concentration. Conclusions: The prevalence of stroke and the high risk of stroke were high among adults aged ≥51 years in Palestine. Hypertension was the highest risk factor for stroke. The serum MMP-9 could be an important prognostic factor for the stroke.

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Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data

Cited by 26 publications

References 41 publications

Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies?

Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies?

Socioeconomic inequalities in lung cancer – a time trend analysis with German health insurance data

The Correlation of Matrix Metalloproteinase-9 With Stroke and Prevalence, Risk Factors, and Knowledge of Stroke Among Palestinians

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