Stroke Incidence, Recurrence, and Case-Fatality in Relation to Socioeconomic Position

Abstract

Background and Purpose-Low socioeconomic status is associated with increased incidence of stroke. This study investigated stroke incidence, recurrence, and case-fatality after stroke among middle-aged Swedish men and women and whether this association differs by gender or stroke subtype. Methods-A total of 69 625 (49% men) citizens, aged 40 to 65 years, living in the city of Malmö in 1990 were studied in relation to total annual income and occupation class, ie, 2 indicators of socioeconomic status. Incidence of first-ever stroke, stroke recurrence, and case-fatality (death within 28 days or 1 year after stroke) were studied over 10 years of follow-up. Results-During the follow-up, a total of 1648 subjects developed a first-ever stroke of whom 275 also experienced a recurrent stroke. By using Cox regression model with covariate adjustments, the incidence of stroke was significantly increased (relative risk: 1.75, 95% CI:1.36 to 2.25) in women who were in the lowest quartile of income compared with the women being in the highest quartile. Corresponding relative risk in men was 1.29 (1.06 to 1.58). Both in men and women, income was significantly associated with ischemic, but not hemorrhagic, subtypes of stroke. Similar relationships were observed between occupation level and incidence of stroke. In addition, low income was associated with higher 28-day and 1-year fatality rates in men (relative risk: 3.13, 1.35 to 7.24 and 2.17, 1.18 to 4.00, respectively), but not in women. In contrast, recurrence of stroke was inversely associated with income only in women. Conclusions-Incidence of stroke, stroke recurrence, and case-fatality increased with decreasing socioeconomic status; however, this relationship differed by gender and subtype of events.

Hyperglycaemia is associated with changes in the regional concentrations of glucose and myo-inositol within the brain

“…Therefore, the individuals initially eligible for this study were excluded if they had any history of severe hypoglycaemia or clinical signs of severe micro-or macrovascular complications ( Table 1). The impact of blood pressure, lipid profile, homocysteine, C-reactive protein, endothelial selectin and social class were assessed in order to control for factors that increase the risk of micro-and macrovascular endothelial injury [32,33]. Nevertheless, the small number of participants and the cross-sectional study design are important limitations of this study.…”

Country of birth and risk of hospitalization due to heart failure: a Swedish population-based cohort study

“…Age and male sex were, independently of marital status, housing condition and annual income, related to an increased risk of HF hospitalization, (12,(38)(39)(40). In a Swedish study rented home was associated with cardiovascular mortality (40).…”

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

“…What drives this relationship is unclear because comparisons between published studies are difficult to make due to the heterogeneity of the studies, including the choice of which indicator of SES to measure (income, education, occupation, class, and so forth). The fact remains that these proxy measures of SES have been shown to be inversely associated with stroke case fatality, poorer functional and motor recovery during rehabilitation, less health services after stroke, and increased recurrent stroke risk [62][63][64][65]. Stroke burden and mortality vary greatly geographically, but low-income countries are the most affected ( Fig.…”