Published online before print January 15, 2004, doi: 10.1161/01.STR.0000109225.11509.EE
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2004;35:432.)
© 2004 American Heart Association, Inc.
Original Contributions |
Educational Level and Stroke Mortality
A Comparison of 10 European Populations During the 1990s
From the Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands (M.A., A.E.K., M.H., F. van L., J.P.M.); Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland (M.B.); Municipal Health Service, Barcelona, Spain (C.B.); Department of Sociology, University of Helsinki, Helsinki, Finland (T.V.); Department of Preventive Medicine and Public Health, University of Madrid, Madrid, Spain (E.R.); Department of Public Health and Microbiology, University of Turin, Turin, Italy (G.C., T.S.); Health and Care Division, Office for National Statistics, London, UK (A.D.); Division for Health Statistics, Statistics Norway, Oslo, Norway (J-K.B.); Interface Demography, Free University Brussels, Brussels, Belgium (P.D., S.G.); and Research and Methodology Division, Statistics Denmark, Copenhagen, Denmark (O.A.).
Reprint requests to Mauricio Avendaño, MPH, Department of Public Health, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, Netherlands. E-mail m.avendanopabon{at}erasmusmc.nl
Background and Purpose— Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged 
30 years in 10 European populations during the 1990s.
Methods— Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy.
Results— Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women.
Conclusions— Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.
Key Words: epidemiology • Europe • mortality • social class • stroke
This article has been cited by other articles:
 |
|
 |
|
  M. Avendano and M. M. Glymour Stroke Disparities in Older Americans: Is Wealth a More Powerful Indicator of Risk Than Income and Education? Stroke, May 1, 2008; 39(5): 1533 - 1540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Bopp, A. Spoerri, M. Zwahlen, F. Gutzwiller, F. Paccaud, C. Braun-Fahrlander, A. Rougemont, and M. Egger Cohort Profile: The Swiss National Cohort--a longitudinal study of 6.8 million people Int. J. Epidemiol., March 7, 2008; (2008) dyn042v1. [Full Text] [PDF]
|
|
|
|
 |
|
 K Harald, S Koskinen, P Jousilahti, J Torppa, E Vartiainen, and V Salomaa Changes in traditional risk factors no longer explain time trends in cardiovascular mortality and its socioeconomic differences J. Epidemiol. Community Health, March 1, 2008; 62(3): 251 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Avendano, I. Kawachi, F. Van Lenthe, H. C. Boshuizen, J. P. Mackenbach, G.A.M. Van den Bos, M. E. Fay, and L. F. Berkman Socioeconomic Status and Stroke Incidence in the US Elderly: The Role of Risk Factors in the EPESE Study Stroke, June 1, 2006; 37(6): 1368 - 1373. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Avendano, A E Kunst, M Huisman, F V Lenthe, M Bopp, E Regidor, M Glickman, G Costa, T Spadea, P Deboosere, et al. Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s Heart, April 1, 2006; 92(4): 461 - 467. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Regidor, J. L Gutierrez-Fisac, J. R Banegas, V. Dominguez, and F. Rodriguez-Artalejo Association of adult socioeconomic position with hypertension in older people J. Epidemiol. Community Health, January 1, 2006; 60(1): 74 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Borrell, A Plasencia, M Huisman, G Costa, A Kunst, O Andersen, M Bopp, J-K Borgan, P Deboosere, M Glickman, et al. Education level inequalities and transportation injury mortality in the middle aged and elderly in European settings Inj. Prev., June 1, 2005; 11(3): 138 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. U. Weir, A. Gunkel, M. McDowall, and M. S. Dennis Study of the Relationship Between Social Deprivation and Outcome After Stroke Stroke, April 1, 2005; 36(4): 815 - 819. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Arrich, W. Lalouschek, and M. Mullner Influence of Socioeconomic Status on Mortality After Stroke: Retrospective Cohort Study Stroke, February 1, 2005; 36(2): 310 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Avendano, A. E. Kunst, F. van Lenthe, V. Bos, G. Costa, T. Valkonen, M. Cardano, S. Harding, J-K. Borgan, M. Glickman, et al. Trends in Socioeconomic Disparities in Stroke Mortality in Six European Countries between 1981-1985 and 1991-1995 Am. J. Epidemiol., January 1, 2005; 161(1): 52 - 61. [Abstract] [Full Text] [PDF]
|
|