Published online before print October 30, 2003, doi: 10.1161/01.STR.0000101664.02943.69
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(Stroke. 2003;34:2628.)
© 2003 American Heart Association, Inc.
Original Contributions |
Editorial Comment—Down With the Class Society!
Department of Medicine, University Hospital, Umeå, Sweden
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
In industrialized countries, people with a low level of education and those who have unskilled manual work are clearly at higher risk for being afflicted by stroke than people with university education or nonmanual employment.1–5 As convincingly demonstrated in a study from Glasgow in this issue of Stroke, this is at least partly due to a more unfavorable risk factor profile (such as higher blood pressure and more smoking) among people living in deprived areas.
It comes as no surprise that there is a social patterning of risk factors for stroke.6,7 An important question is if this is entirely due to personal factors or if societal factors also contribute. Multilevel analyses have shown that the area/community a person is living in has an influence on risk factors for cardiovascular disease that goes above and beyond the individual level of education.8
Once a stroke has occurred, are affluent and deprived people treated equally? The Glasgow investigators report that early case fatality does not differ by degree of deprivation, a finding similar to what has been observed in the Scandinavian countries.2,3 However, a Canadian study showed reduced early survival after stroke in low-income people.9 Worse long-term survival after stroke in people of low social class has been reported from Finland3 and, now, from Scotland.
In the Canadian study, the effect of socioeconomic status was not small: each $10 000 increase in median neighborhood income was associated with a 9% reduction in the hazard of death at 30 days. In that study,