Temporal Trends in Incidence of Myocardial Infarction and Ischemic Stroke by Socioeconomic Position in Sweden 1987–2010

Abstract

BackgroundWe analyzed temporal trends in the incidence of myocardial infarction and ischemic stroke in Sweden by socioeconomic position and investigated whether social inequalities in incidence of these diseases changed over time.Materials and MethodsWe studied a cohort of almost three million Swedish residents born between 1932 and 1960 followed from 1987 until 2010. Incident cases of myocardial infarction and ischemic stroke were identified in the Swedish National Inpatient Register and Cause of Death Register. Socioeconomic position was retrieved from the Population and Housing Censuses. Incidence rates of myocardial infarction and ischemic stroke and incidence rate ratios comparing levels of socioeconomic position were estimated using flexible parametric survival models adjusted for calendar year, attained age, sex, and birth country.ResultsThe overall incidences of myocardial infarction and ischemic stroke decreased over time among men, but were stable over time among women. With regard to ischemic stroke incidence, socioeconomic inequality increased over time in the age group 55 to 59: the incidence rate ratios for low manual compared to high non-manual increased from 1.3 (95% CI: 1.2–1.4) in 1997 to 1.5 (1.4–1.7) in 2010 among men, and from 1.4 (1.3–1.6) in 1997 to 2.1 (1.8–2.5) in 2010 among women. The socioeconomic inequality in incidence of myocardial infarction was stable over time for both men and women.ConclusionThere was a decrease in myocardial infarction and ischemic stroke incidence over time among men but no significant change for women. Our study highlights existing, and in some cases increasing, social inequalities in the incidence of cardiovascular diseases.

Trends in Diagnosis‐Specific Work Disability Before and After Stroke: A Longitudinal Population‐Based Study in Sweden

“…The strong contribution of socioeconomic confounders to the work disability trends, particularly before the stroke, was expected given the strong evidence on socioeconomic patterning of stroke and work disability . An explanation for the strengthening of the associations could be related to differences in access to treatment or variation in timing of treatment between socioeconomic groups.…”

“…The strong contribution of socioeconomic confounders to the work disability trends, particularly before the stroke, was expected given the strong evidence on socioeconomic patterning of stroke and work disability. [12][13][14][15] An explanation for the strengthening of the associations could be related to differences in access to treatment or variation in timing of treatment between socioeconomic groups. Thus, groups with a lower absolute level of stroke and work disability could be more likely to be hospitalized earlier and to survive after their stroke and also differ with respect to the likelihood of work disability, for example, attributed to different social and material circumstances and working conditions.…”

“…Stroke is also known to disproportionally affect people in socioeconomically disadvantaged situations, even in high‐income countries . Furthermore, although stroke incidence has been decreasing in Sweden, particularly in men, a register‐based study of more than 3 million residents in Sweden showed that inequalities in stroke persist and have even widened . Similarly, in large Danish register‐based studies, low socioeconomic position has been linked to both the risk of stroke and poorer stroke survival .…”

“…12 Furthermore, although stroke incidence has been decreasing in Sweden, particularly in men, a register-based study of more than 3 million residents in Sweden showed that inequalities in stroke persist and have even widened. 13 Similarly, in large Danish register-based studies, low socioeconomic position has been linked to both the risk of stroke 14 and poorer stroke survival. 15 Given these previous results, and also attributed to the socioeconomic patterning of work disability, 16,17 socioeconomic factors need to be considered when focusing on trends in diagnosis-specific work disability among stroke patients.…”

Herausforderung Demografie

“…Das heißt, bei Frauen gab es im 23-Jahres-Zeitraum eine gleich bleibende, bei Männern eine verringerte Schlaganfall-und Herzinfarkthäufigkeit. Allerdings fand man insbesondere bei der Schlaganfallhäufigkeit (jedoch nicht bei der Herzinfarkthäufigkeit) sozioökonomische Ungleichheiten [18].…”