Socioeconomic Status and Stroke Incidence in the US Elderly

Abstract

Background and Purpose-This study assesses the effect of socioeconomic status on stroke incidence in the elderly, and the contribution of risk factors to stroke disparities. Methods-Data comprised a sample of 2812 men and women aged 65 years and over from the New Haven cohort of the Established Populations for the Epidemiologic Studies of the Elderly. Individuals provided baseline information on demographics, functioning, cardiovascular and psychosocial risk factors in 1982 and were followed for 12 years. Proportional hazard models were used to model survival from initial interview to first fatal or nonfatal stroke. Results-Two hundred and seventy subjects developed incident stroke. At ages 65 to 74, lower socioeconomic status was associated with higher stroke incidence for both education (HR lowest/highest ϭ2.07, 95% CI, 1.04 to 4.13) and income (HR lowest/highest ϭ2.08, 95% CI, 1.01 to 4.27). Adjustment for race, diabetes, depression, social networks and functioning attenuated hazard ratios to a nonsignificant level, whereas other risk factors did not change associations significantly. Beyond age 75, however, stroke rates were higher among those with the highest education (HR lowest/highest ϭ0.42, 95% CI, 0.22 to 0.79) and income (HR lowest/highest ϭ0.43, 95% CI, 0.22 to 0.86), which remained largely unchanged after adjustment for risk factors. Conclusions-We observed substantial socioeconomic disparities in stroke at ages 65 to 74, whereas a crossover of the association occurred beyond age 75. Policies to improve social and economic resources at early old age, and interventions to improve diabetes management, depression, social networks and functioning in the disadvantaged elderly can contribute to reduce stroke disparities.

Combined Effects of Socioeconomic Position, Smoking, and Hypertension on Risk of Ischemic and Hemorrhagic Stroke

“…23 Such apparent differential vulnerability could be a consequence of clustering and mutual interaction between other active determinants. 24 Although others have described the important role of smoking and hypertension as contributors to the social gradients in stroke, [9][10][11][12] our data indicated only sparse differential exposure to hypertension across socioeconomic groups. Likewise, in previous trend studies during the 1980s and 1990s, no marked socioeconomic differences in blood pressure have been reported.…”

“…7,8 The mechanisms driving social inequality in stroke have been described as being partly a result of differential exposure to well-established risk factors, such as hypertension and smoking, during a life course. [9][10][11][12] In previous studies, authors have suggested that smoking has a larger effect on ischemic stroke, hemorrhagic stroke, and heart disease if high blood pressure is also present. 3,5,[13][14][15] However, much less attention has been given to the extent to which these risk factors interact with socioeconomic exposures.…”

Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study

“…We then divided our sample into three equally sized groups (tertiles) according to this score; the first tertile (score: ,4) was termed 'low SES', the second tertile was 'medium SES' (score: 4-10) and the third tertile was 'high SES' (score: .10). This type of assessment of SES has already been used in the literature (30) and it is not unusual in the quantification of SES for only one or two of its components (education, income and occupation) to be combined (31,32) . Of course, education level and financial status in multi-adjusted models could also be independently used.…”

Depression and Risk of Stroke in Midaged Women

“…8,9 An association between depression and stroke was observed in women included in the Nurses' Health Study, but age-specific effects were not reported. 10 Important age group differences may therefore have been masked in previous studies where associations were not stratified by age.…”