Published Online
on January 19, 2006

A more recent version of this article appeared on March 1, 2006

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Submitted on October 19, 2005
Revised on December 1, 2005
Accepted on December 5, 2005

Greater Incidence of Both Fatal and Nonfatal Strokes in Disadvantaged Areas. The Northeast Melbourne Stroke Incidence Study

Amanda G. Thrift PhD^*; Helen M. Dewey PhD; Jonathan W. Sturm PhD; Seana L. Paul BSc (Hons); Amanda K. Gilligan PhD; Velandai K. Srikanth PhD; Richard A.L. Macdonell MD; John J. McNeil PhD; Malcolm R. Macleod PhD; and Geoffrey A. Donnan MD

From the National Stroke Research Institute (A.G.T., H.M.D., J.W.S., S.L.P., A.K.G., V.K.S., M.R.M., G.A.D.), Austin Health, Heidelberg Heights, Victoria, Australia; Neurology Department (A.G.T., H.M.D., A.K.G., R.A.L.M., G.A.D.), Austin Health, Heidelberg Heights, Victoria, Australia; Department of Epidemiology and Preventive Medicine (A.G.T., J.J.M.), Monash University, Prahran, Australia; Department of Medicine (A.G.T., H.M.D., R.A.L.M., G.A.D.), University of Melbourne, Heidelberg, Australia; Department of Neurology (J.W.S.), Central Coast Area Health, Gosford, NSW, Australia; Eastern Neurosciences (A.K.G.), Box Hill Hospital, Box Hill, Australia; Department of Medicine (A.K.G.), Monash University, Box Hill, Australia; Menzies Research Institute (V.K.S.), Hobart, Australia; and Division of Clinical Neurosciences (M.R.M.), University of Edinburgh, Edinburgh, United Kingdom.

^* To whom correspondence should be addressed. E-mail: thrift{at}unimelb.edu.au.

Background and Purpose--Greater stroke mortality has been reported among lower socioeconomic groups. We aimed to determine whether fatal, nonfatal, and overall stroke incidence varied by socioeconomic status.

Methods--All suspected strokes occurring in 22 postcodes (population of 306 631) of Melbourne, Australia, during a 24-month period between 1997 and 1999 were found and assessed. Multiple overlapping sources were used to ascertain cases with standard clinical definitions for stroke. Socioeconomic disadvantage was assigned in 4 bands from least to greatest using an area-based measure developed by the Australian Bureau of Statistics.

Results--Overall stroke incidence (number per 100 000 population per year), adjusted to the European population 45 to 84 years of age, increased with increasing socioeconomic disadvantage: 200 (95% CI, 173 to 228); 251 (95% CI, 220 to 282); 309 (95% CI, 274 to 343); and 366 (95% CI, 329 to 403; ² for ranks; P<0.0001). Similar incidence patterns were observed for both fatal and nonfatal stroke. Nonfatal stroke contributed most to this incidence pattern: 146 (95% CI, 122 to 169); 181 (95% CI, 155 to 207); 223 (95% CI, 194 to 252); and 280 (95% CI, 247 to 313; ² for ranks; P<0.0001).

Conclusions--In this population-based study, both fatal and nonfatal stroke incidence increased with increasing socioeconomic disadvantage. The greater contributor to this incidence pattern was nonfatal stroke incidence. This may have implications for service provision to those least able to afford it. Area-based identification of those most disadvantaged may provide a simple and effective way of targeting regions for stroke prevention strategies.

Key words: cerebrovascular disorders • epidemiology • incidence • socioeconomic factors

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