Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke

Glymour, M. Maria; Avendaño, Mauricio; Haas, Steven A.; Berkman, Lisa F.

doi:10.1016/j.annepidem.2008.09.010

Cited by 86 publications

(79 citation statements)

References 59 publications

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“…In contrast to a previous study from our group that focused on dental health and particularly periodontitis as a stroke risk factor and that guided several hypotheses for the present work [22], paternal profession was not an independent risk factor of stroke here. In other studies, childhood socioeconomic conditions predicted stroke risk independently of social status in adulthood [18,21]. Professional training was the one social factor that was most strongly associated with stroke risk, although behavioral and other risk factors clearly influenced its predictive value.…”

Section: Discussionmentioning

confidence: 99%

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Childhood and Adult Social Conditions and Risk of Stroke

Grau

Ling²,

Palm³

et al. 2012

Cerebrovasc Dis

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Background: Socioeconomic conditions may strongly influence the risk of stroke. We tested the hypotheses that indexes of social status in different life periods including childhood are inversely associated with stroke risk and that there is a cumulative effect of social conditions during lifetime on the risk of stroke. Furthermore, we investigated whether social advancement compared to the parental generation is associated with reduced stroke risk. Methods: In a case-control study, we assessed parental professional status, highest school degree, professional education and the last professional activity in 370 consecutive patients with ischemic or hemorrhagic stroke or transient ischemic attack [TIA; age 60.7 ± 12.8 years (mean ± standard deviation); 31.1% women] and 370 age- and sex-matched control subjects randomly selected from the general population of the same area. Results: Higher level of school exams [odds ratio (OR) 0.58, 95% confidence interval (CI) 0.39–0.86], university or polytechnic high school degrees (OR 0.39, 95% CI 0.24–0.63), nonmanual (last or current) professional activity (OR 0.51, 95% CI 0.37–0.71) and father’s nonmanual professional activity (OR 0.64, 95% 0.43–0.97) were associated with a lower risk of stroke/TIA. Adjustment for vascular risk factors including current smoking and alcohol consumption reduced the strength of these associations and rendered them nonsignificant except for university or polytechnic high school degrees (OR 0.49, 95% CI 0.27–0.87). Additional adjustment for regular sports activity further attenuated the association between academic degrees and risk of stroke/TIA (OR 0.56, 95% CI 0.31–1.02). A score summarizing 4 lifetime social indexes was not independently associated with stroke risk (OR 0.67, 95% CI 0.39–1.16). Social advancement as assessed by changes from paternal manual work to nonmanual work in the index generation was more common among control subjects (23.5%) than patients (15.3%; p = 0.0097), but such advancement was not independently associated with stroke/TIA after adjustment for all covariables (OR 0.82, 95% CI 0.50–1.33). Conclusions: Socioeconomic conditions were inversely linked to the risk of stroke/TIA. These associations were strongly influenced by lifestyle factors such as smoking, alcohol consumption and mainly sports activity. Stroke preventive strategies may have a particularly large potential if they focus on such lifestyle habits in socially disadvantaged groups.

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Section: Discussionmentioning

confidence: 99%

“…Variations in disease risk may be partly determined by cumulative differential exposure to adverse material conditions and behavioral and psychosocial risks during an individual’s lifetime [21]. We adopted a life course perspective and assessed indicators of social status during various periods of life.…”

Section: Discussionmentioning

confidence: 99%

Childhood and Adult Social Conditions and Risk of Stroke

Grau

Ling²,

Palm³

et al. 2012

Cerebrovasc Dis

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“…20,27 In a US national longitudinal study, adjustment for both childhood and adult social conditions explained nearly all the association between ethnicity and stroke incidence. 28 A study reported that 14% to 64% of the increased stroke mortality in black men was explained by socioeconomic factors but with no significant association in black women. 27 Studies on mortality differences between blacks and whites have however been inconsistent with some studies reporting an increased mortality and others demonstrating a survival advantage in blacks.…”

Section: Ethnic Differencesmentioning

confidence: 99%

Socioeconomic Status and Stroke

Addo

Ayerbe

Mohan

et al. 2012

Stroke

304

274

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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.

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“…This approach provides a framework to establish priorities in service and research areas. 39 There are many possible explanations for why racial-ethnic disparities exist, including cultural variations in perceptions of health and the healthcare system, environmental exposures, genetic factors, 40 SES, 41 disadvantage in early childhood, 42 fear, mistrust, prejudice, 39 and educational level. 43 The goal of Healthy People 2010 was to eliminate these disparities.…”

Section: Definitionsmentioning

confidence: 99%

Racial-Ethnic Disparities in Stroke Care: The American Experience

Cruz‐Flores¹,

Rabinstein²,

Biller³

et al. 2011

Stroke

421

261

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Purpose-Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. Results-There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage, mistrust of the healthcare system, the relatively limitedThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on April 6, 2011. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@woltersklu...

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Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke

Cited by 86 publications

References 59 publications

Childhood and Adult Social Conditions and Risk of Stroke

Childhood and Adult Social Conditions and Risk of Stroke

Socioeconomic Status and Stroke

Racial-Ethnic Disparities in Stroke Care: The American Experience

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