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(Stroke. 2007;38:4.)
© 2007 American Heart Association, Inc.

Editorials

The Socioeconomic Stroke Puzzle

Tobias Kurth, MD, ScD Klaus Berger, MD, MPH, MSc

From the Divisions of Aging and Preventive Medicine (T.K.), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; the Department of Epidemiology (T.K.), Harvard School of Public Health, Boston, Mass; and the Institute of Epidemiology and Social Medicine (K.B.), University of Muenster, Germany.

Correspondence to Tobias Kurth, Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave, East 3rd floor, Boston, MA 02215-1204. E-mail tkurth@rics.bwh.harvard.edu

See related article, pages 27–33

Key Words: epidemiology • risk factors • socioeconomic status • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Several studies using different study designs and various definitions of socioeconomic status have shown that stroke incidence increases with decreasing socioeconomic status.^1–8 A low socioeconomic status predicts stroke not only in poor countries but also in well-developed countries with a high standard of medical care.^1,4,8 The mechanisms by which socioeconomic status influences stroke risk are not entirely understood. Potential explanations include differences in major stroke risk factors, in psychosocial factors, and in access to and use of medical care.^1,5

In this issue of Stroke, Kuper and colleagues evaluate the association between socioeconomic status, as measured by years of education, and the risk of stroke in a large prospective study of Swedish women.⁹ In age-adjusted analyses, years of education were inversely associated with stroke risk, indicating that women in the lowest education group had an 2-fold increased risk of total stroke. Furthermore, Kuper and colleagues evaluated whether the association between socioeconomic status and stroke could be explained by established stroke risk factors as well as by psychosocial factors. The increased risk of stroke in the lower socioeconomic class attenuated to a relative risk of 1.5 (95% CI, 1.0 to 2.2) after adjustment for age, smoking status, body mass index, alcohol consumption, diabetes, elevated blood pressure, and exercise. This attenuation is in line with other studies that showed reduction of the relative risk estimate after adjusting for traditional stroke risk factors, particularly behavioral factors.^1,8 Because information on lifestyle factors can only be measured imperfectly and information on some factors may not . . . [Full Text of this Article]

Related Article:

The Socioeconomic Gradient in the Incidence of Stroke: A Prospective Study in Middle-Aged Women in Sweden

Hannah Kuper, Hans-Olov Adami, Töres Theorell, and Elisabete Weiderpass
Stroke 2007 38: 27-33. [Abstract] [Full Text] [PDF]

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