Socioeconomic status and lifestyle in young ischaemic stroke patients: a possible relationship to stroke recovery and risk of recurrent event

Abstract

Objectives: Socioeconomic status (SES) and lifestyle have impact on recovery after ischaemic stroke (IS) and on risk of recurrent ischaemic stroke (RIS) in elderly patients. With regard to currently available limited data on young people, we aimed to assess SES and parameters of lifestyle and evaluate their relationship to stroke recovery and risk of RIS in young patients.Methods: We analysed consecutive young IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischaemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). Data were acquired from structured a self-evaluating multiple-choice questionnaire. Clinical outcome was assessed using the Modified Rankin Scale (MRS) after 3 months with score 0-1 for excellent outcome.Results: Data were obtained from 297 (163 males, mean age 39.6 ± 7.8 years) young patients. Patients with MRS 0-1 (237, 79.8%) did not differ in SES except university education (21.1 vs. 3.3%; p = 0.001), less smoked (16.5 vs. 58.3%; p < 0.001), more of them did regular sport activities (79.1 vs. 51.6%; p = 0.02) and passed regular preventive medical checks (45.6 vs. 24.2%; p = 0.01). Twelve (4%) patients suffered from RIS during a follow-up with median of 25 months. They did not differ in SES but had higher body mass index (31.6 vs. 26.7; p = 0.007), reported less regular sport activities (16.7 vs. 73.0%; p < 0.001) and less regular medical checks (8.3 vs. 40.0%; p = 0.001). Conclusion:In young patients, SES had no relationship to clinical outcome after IS and to risk of RIS except education level. Some parameters of health lifestyle were presented more in patients with excellent outcome and without RIS during the follow-up.

Influence of socioeconomic status on functional outcomes after stroke: a systematic review and meta-analysis

“…Seventeen were cohort studies 7,[17][18][19][20][21][22][23][24][25][26][27][30][31][32][33][34] , most large population-based multicentre cohort studies, 7, 18-21, 27, 31 and two were cross-sectional. 28,29 Six studies were conducted in China, 20,25,28,31,33,34 four in the United States (US), 18,19,24,30 two each in Iran, 22,29 Germany, 26,27 and the United Kingdom (UK) 7,21 and one each in the Czech Republic, 23 Peru, 17 and The Netherlands. 32 In total, these studies included 157,715 stroke patients, of which 47.7% were female.…”

“…When health insurance status was used as the SES indicator, the pooled OR indicated a similar association although statistical significance was not achieved. The pooled OR from 11 studies, 19,20,22,23,[25][26][27][31][32][33][34] involving 32,083 patients, showed that the lowest level of education attained was associated with 66% higher odds (OR 1.66 [95% CI 1.40 -1.95]) of poor functional outcome after stroke compared to highest level of education attained (not completed or below high school versus high school or above), 2, Supplemental Figure 1).…”

“…Characteristics of included studies are summarised in Table 1. Thirteen studies included 151,309 acute ischaemic stroke patients, 18–20, 23–27, 29, 31, 33, 34 three included a combined sample of 3,253 ischaemic stroke and intracerebral haemorrhage (ICH) patients, 7, 17, 32 and three included a combined sample of 3,153 patients with any stroke subtype (ischaemic stroke, ICH, and subarachnoid haemorrhage) 8, 21, 22 .…”

“…Thirteen studies assessed functional outcome with the mRS, 7, 17–20, 23–25, 28, 30, 31, 33, 34 three used the BI, 21, 22, 27 two studies assessed functional outcome separately with mRS and BI, 22, 32 and one study combined results from the mRS and BI. 26 The period of functional outcome assessment ranged from the point of hospital discharge to up to 5 years following stroke onset.…”

A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke

“…Considering that social isolation and influence of social determinants increase IS incidence among older populations [89,90], it may be expected that such social factors would carry similar impact in young cohorts. Direct studies are limited; however, current reports have found that young patients who achieved a favorable post-IS outcome (modified Rankin Scale [mRS] score of 0-1) were more likely to be college educated and practice sports [91]. Studies of premature heart disease have shown elevated burdens of risk factors, including those with important links to premature IS, in patients with low socioeconomic status.…”