Socioeconomic Status and Stroke

Abstract

Background and Purpose— Rates of stroke incidence and mortality vary across populations with important differences between socioeconomic groups worldwide. Knowledge of existing disparities in stroke risk is important for effective stroke prevention and management strategies. This review updates the evidence for associations between socioeconomic status and stroke. Summary of Review— Studies were identified with electronic searches of MEDLINE and EMBASE databases (January 2006 to July 2011) and reference lists from identified studies were searched manually. Articles reporting the association between any measure of socioeconomic status and stroke were included. Conclusions— The impact of stroke as measured by disability-adjusted life-years lost and mortality rates is >3-fold higher in low-income compared with high- and middle-income countries. The number of stroke deaths is projected to increase by >30% in the next 20 years with the majority occurring in low-income countries. Higher incidence of stroke, stroke risk factors, and rates of stroke mortality are generally observed in low compared with high socioeconomic groups within and between populations worldwide. There is less available evidence of an association between socioeconomic status and stroke recurrence or temporal trends in inequalities. Those with a lower socioeconomic status have more severe deficits and are less likely to receive evidence-based stroke services, although the results are inconsistent. Poorer people within a population and poorer countries globally are most affected in terms of incidence and poor outcomes of stroke. Innovative prevention strategies targeting people in low socioeconomic groups are required along with effective measures to promote access to effective stroke interventions worldwide.

Social stratification in the dissemination of statins after stroke in Sweden

“…Socioeconomic differences are not unique to Swedish stroke care. In an international review the evidence is strongest for mortality and incidence of stroke but there is evidence also for outcome and stroke severity [30]. Differences in risk factors, and accordingly prevention of risk factors, are probably part of a complex mechanism for socioeconomic differences in stroke.…”

Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites

“…Most nSES studies have been restricted to stroke mortality or have not accounted for individual-level SES or modifiable stroke risk factors. 6,11,[13][14][15][16] …”

“…9 Recently, studies exploring long-term implications of neighborhood exposures on health outcomes have been reported. [10][11][12] While much attention has focused on the impact of individual socioeconomic status (SES) on risk of stroke, 11,13 there is limited research on the relationship between neighborhood socioeconomic characteristics (nSES) and stroke risk. Most nSES studies have been restricted to stroke mortality or have not accounted for individual-level SES or modifiable stroke risk factors.…”

“…Most nSES studies have been restricted to stroke mortality or have not accounted for individual-level SES or modifiable stroke risk factors. 6,11,[13][14][15][16] Further, most studies in the United States have not been national, using data from only a few communities. 7,[15][16][17] In US studies where nSES has been used as a proxy for individual SES, living in socioeconomically disadvantaged neighborhoods confers an increased risk of incident stroke in most 7,15,16 but not all studies.…”

Residential zip code influences outcomes following hospitalization for acute pulmonary embolism in the United States

“…4,5,8,[28][29][30] Although the overall rates of thrombolysis in this cohort were low, there was an apparent disparity according to socioeconomic class in this large representative population. It must be recognized that unlike acute myocardial infarction and acute ischemic stroke, acute PE is often misdiagnosed or underdiagnosed in clinical settings.…”