Income, education influence mortality after stroke in Sweden

These findings echo research from other parts of the world, highlighting the need to address social determinants of health.

BASEL, Switzerland – Patients with higher income and education levels have a lower risk of dying after a stroke, according to a study in Gothenburg, Sweden.

Individuals with more education had a 25.7% lower risk of death compared with those with only an elementary school education and a 32.3% lower risk among those with higher versus lower incomes, says Katharina Stiebrant Sunnerhagen, MD, PhD (Sahlgrenska University Hospital and University). Gothenburg, Sweden), reported here at the European Stroke Organization Conference (ESOC) 2024.

In addition, a large number of adverse social determinants of health as well as risk of death after stroke increased, including education, income, region of residence, and country of birth.

“I've always felt that people bring with them not only disease, but also their history and living situation, and all of that impacts what we do,” Sunnerhagen told TCTMD. And, indeed, these findings are consistent with prior research in the United States and elsewhere, for example, in adults with greater “social vulnerability.” Higher risk of dying prematurely from CVDIncluding stroke.

Since the current study was conducted in a country with tax-funded health care, the observed disparities cannot be explained solely on the basis of access to care, however, as lower-income individuals are less likely to be able to take time off from work. Is. -And potentially lost wages for a doctor's visit. They also noted that higher income is associated with higher levels of education, which is associated with greater health literacy (i.e., knowing how to take care of one's health and when to seek care).

The study should raise awareness that inequities persist even in the public-payment system, Sunnerhagen said. “There are things in the health service that we can work with, but there are also things that we can't solve ourselves, so we need to tell politicians what there are [problems] This needs to be addressed in society if you want a more equitable health status for your citizens.

'Worrying' findings

Incorporating data from both local and national registries, the study included 6,901 Gothenburg residents (average age 76 years; 47% women) who had a stroke between November 2014 and December 2019. Nearly half (48.1%) had no adverse social determinants of health, while 36.5% had one, 12.8% had two, 2.3% had three and 0.2% had four.

Although more favorable education and income levels were associated with a lower risk of mortality after stroke, region of residence and country of birth did not affect the risk. In an analysis looking at the number of adverse social determinants of health, having one such factor was associated with a 17.5% increased risk of mortality and having two or more was associated with a 24.3% increased risk.

These findings are not surprising, commented Annemijan Algra, MD, PhD (UMC Utrecht, Netherlands), as they are consistent with her clinical experience and data from the Global Burden of Disease, Injuries, and Risk Factors Study, which showed Has gone Increase in stroke-related mortality and disability in low-income areas,

“This is a reflection of the increased risk of certain risk factors, and that is worrying,” said Algra, who is chairman. ESOC Public Relations Committee.

People bring with them not only disease, but also their history and their living conditions, and all of this impacts our actions. Katharina Stibrant Sunnerhagen

Addressing potential contributors to the poor outcomes among low-income individuals observed in the current study, Algra pointed out that “low-income areas often have poor access not only to care, but also to healthy food and healthy behaviors.” There is poor access.”

As possible solutions to the inequalities, he cited tools such as brain care score Developed by researchers at the McCance Center for Brain Health at Massachusetts General Hospital in Boston. “We're so focused on all the things that are bad for us and the risks they're bringing, but I think it's important to frame it in a positive way so that you can take care of yourself by doing the right things, exercising, taking care of your brain.” Eating more vegetables, quitting smoking, controlling your blood pressure and things like that, I think that's one of the things that I find very promising and it is very important.

But like Sunnerhagen, Algra indicated that solutions will also have to come from outside the health care system. He stressed, “This is not only something that we as doctors can do from inside the hospital – of course we can promote it – but it is also something where our governments have to promote brain health. “

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