BACKGROUND: stroke has been shown to follow a social gradient with incidence rising as socioeconomic status decreases. OBJECTIVE: to examine the relationship between socioeconomic status and ischaemic stroke risk amongst older people. SETTING: the Cities of Bordeaux, Dijon and Montpellier in France. SUBJECTS AND METHODS: nine thousand and two hundred and ninety-four non-institutionalised persons aged 65 years or more followed for 6 years. RESULTS: the distribution of cardiovascular risks factors was consistent with the classical finding of more favourable risk profiles among the advantaged socioeconomic groups. One hundred and thirty-six individuals developed a first ever ischaemic stroke (incidence rate: 3.2 per 1,000 py (person-years), 95% CI 2.7-3.8). The age- and sex-adjusted incidence of ischaemic stroke increased with increasing level of income (from 2.4 to 4.1 per 1,000 py, P = 0.04). In the multivariable analysis adjusting for cardiovascular risk factors, the higher income group displayed a 80% increased risk of ischaemic stroke compared with less wealthy participants (hazards ratio 1.77, 95% CI 1.20-2.61). CONCLUSIONS: in this community-based sample of older individuals, a higher level of household income was associated with a higher risk of ischaemic stroke, a reversal of the social gradient usually reported in younger age groups. Selective survival is one of the potential explanations for this unexpected finding.
BACKGROUND:stroke has been shown to follow a social gradient with incidence rising as socioeconomic status decreases. OBJECTIVE: to examine the relationship between socioeconomic status and ischaemic stroke risk amongst older people. SETTING: the Cities of Bordeaux, Dijon and Montpellier in France. SUBJECTS AND METHODS: nine thousand and two hundred and ninety-four non-institutionalised persons aged 65 years or more followed for 6 years. RESULTS: the distribution of cardiovascular risks factors was consistent with the classical finding of more favourable risk profiles among the advantaged socioeconomic groups. One hundred and thirty-six individuals developed a first ever ischaemic stroke (incidence rate: 3.2 per 1,000 py (person-years), 95% CI 2.7-3.8). The age- and sex-adjusted incidence of ischaemic stroke increased with increasing level of income (from 2.4 to 4.1 per 1,000 py, P = 0.04). In the multivariable analysis adjusting for cardiovascular risk factors, the higher income group displayed a 80% increased risk of ischaemic stroke compared with less wealthy participants (hazards ratio 1.77, 95% CI 1.20-2.61). CONCLUSIONS: in this community-based sample of older individuals, a higher level of household income was associated with a higher risk of ischaemic stroke, a reversal of the social gradient usually reported in younger age groups. Selective survival is one of the potential explanations for this unexpected finding.
Authors: J A A Dalstra; A E Kunst; C Borrell; E Breeze; E Cambois; G Costa; J J M Geurts; E Lahelma; H Van Oyen; N K Rasmussen; E Regidor; T Spadea; J P Mackenbach Journal: Int J Epidemiol Date: 2005-02-28 Impact factor: 7.196
Authors: Mauricio Avendano; Ichiro Kawachi; Frank Van Lenthe; Hendriek C Boshuizen; Johan P Mackenbach; G A M Van den Bos; Martha E Fay; Lisa F Berkman Journal: Stroke Date: 2006-05-11 Impact factor: 7.914
Authors: M Huisman; A E Kunst; O Andersen; M Bopp; J-K Borgan; C Borrell; G Costa; P Deboosere; G Desplanques; A Donkin; S Gadeyne; C Minder; E Regidor; T Spadea; T Valkonen; J P Mackenbach Journal: J Epidemiol Community Health Date: 2004-06 Impact factor: 3.710
Authors: Mauricio Avendaño; Anton E Kunst; Martijn Huisman; Frank van Lenthe; Matthias Bopp; Carme Borrell; Tapani Valkonen; Enrique Regidor; Giuseppe Costa; Angela Donkin; Jens-Kristian Borgan; Patrick Deboosere; Sylvie Gadeyne; Teresa Spadea; Otto Andersen; Johan P Mackenbach Journal: Stroke Date: 2004-01-15 Impact factor: 7.914
Authors: András Folyovich; Ildikó Vastagh; Anna Kéri; Angéla Majoros; Koppány Levente Kovács; András Ajtay; Zsuzsanna Laki; Bence Gunda; Katalin Erdei; Laura Lenti; Zsófia Dános; Dániel Bereczki Journal: Int J Public Health Date: 2015-04-08 Impact factor: 3.380
Authors: Alison D Murray; Christopher J McNeil; Sima Salarirad; Lawrence J Whalley; Roger T Staff Journal: PLoS One Date: 2014-02-18 Impact factor: 3.240
Authors: Su Ra Seo; Su Young Kim; Sang-Yi Lee; Tae-Ho Yoon; Hyung-Geun Park; Seung Eun Lee; Chul-Woung Kim Journal: J Prev Med Public Health Date: 2014-03-31