Education Level Explains Differences in Stroke Incidence among City Districts in Joinville, Brazil: A Three-Year Population-Based Study

Abstract

Background: Current evidence suggests an inverse association between socioeconomic status and stroke incidence. Our aim was to measure the variation in incidence among different city districts (CD) and their association with socioeconomic variables. Methods: We prospectively ascertained all possible stroke cases occurring in the city of Joinville during the period 2005–2007. We determined the incidence for each of the 38 CD, age-adjusted to the population of Joinville. By linear regression analysis, we correlated incidence data with mean years of education (MYE) and mean income per month (MIPM). Results: Of the 1,734 stroke cases registered, 1,034 were first-ever strokes. In the study period, the crude incidence in Joinville was 69.5 per 100,000 (95% confidence interval, 65.3–73.9). The stroke incidence among CD ranged from 37.5 (22.2–64.6) to 151.0 per 100,000 (69.0–286.6). The stroke incidence was inversely correlated with years of education (r = –0.532; p < 0.001). MYE and MIPM were strongly related (R = 0.958), resulting in exclusion of MIPM by collinearity. Conclusions: Years of education can explain a wide incidence variation among CD. These results may be useful to guide the allocation of resources in primary prevention policies.

"EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity"

“…16,18,35 Finally, the contribution of the EMMA cohort related to knowledge of stroke epidemiology in hospital and community settings, thereby enabling comparisons across developing countries that have applied the WHO methodology for stroke surveillance. [36][37][38] Our main limitations related mainly to the initial data collection, which lacked acute neurological evaluation for quantifying stroke severity in most cases.…”

“…14,15 In fact, few authors have assessed long-term stroke survival or post-stroke disability, or even prognostic risk factors among stroke survivors in Brazil. [16][17][18] One of these long-term stroke cohorts is the Study of Stroke Mortality and Morbidity in Adults (EMMA Study), which is an ongoing stroke surveillance survey in which the main objectives are to report on headline mortality rates and to monitor disability and prognostic risk factors among survivors living in a lowincome area of the city of Sao Paulo, Brazil.…”

Prevalence and risk factors for stroke in a population of Southern Brazil

“…Several studies point to be the occurrence of stroke inversely proportional to socioeconomic factors of a population, such as monthly income and education level 27 . Such factors influence access to health services, lifestyle, understanding of pathologies and adherence to treatments 1 …”

The Priority Group Index

“…These subpopulations were chosen as independent variables, because age, sex, race, immigrant status, marital status, education, social economic status, access to health care service (having a regular doctor, language barrier), self-perceived health, employment status, smoking, drinking, physical inactivity, obesity and overweight, unhealthy diets, and geographic location have been found to be associated with heart disease, [31][32][33][34][35][36][37][38] stroke, 37,[39][40][41][42][43][44] and chronic lower respiratory diseases. [45][46][47][48][49][50][51][52][53][54] These factors are also related to health disparities.…”