Income and education linked to lower mortality after stroke

New research presented today at the 10th European Stroke Conference (ESOC) 2024 found that people with high incomes have a 32% lower risk of mortality after a stroke. Additionally, people with higher levels of education had a 26% lower risk of death after a stroke, highlighting the significant differences in stroke survival by key social determinants of health (SDH).

The registry-based study analyzed data from 6901 stroke patients in Gothenburg, Sweden, from November 2014 to December 2019, to examine the impact of SD factors on the risk of mortality after stroke. The study focused on four SDZ factors: area of residence, country of birth, education level and income.

In addition to finding a significant association between income, education level, and risk of mortality after stroke, the study revealed a disturbing trend in the cumulative impact of SD factors. Patients with one adverse SD factor had an 18% higher risk of mortality compared with patients with no adverse SD factor. This risk increased to 24% for patients with two to four unfavorable SD factors.

"Our findings highlight the stark reality that a person's socioeconomic status can be a matter of life and death in the context of stroke, especially when faced with multiple adverse health conditions. Although our study was conducted in Gothenburg, we believe these findings are relevant to across Europe, where similar health structures and levels of social vulnerability exist, highlighting a widespread problem across the continent,” said Katerina Steenbrandt Sunnerhagen, Professor, lead author of the study, University of Gothenburg, Clinical Neurology, Gothenburg, Sweden.

The study also found an association between the increased risk of mortality and additional risk factors such as physical inactivity, diabetes, alcohol abuse and atrial fibrillation.

Findings regarding gender differences and the potential influence of risk factors when examining patient characteristics within the study cohort are also notable. The proportion of women among patients increased with the number of unfavorable SDZ factors; 41% of the group with no adverse SDZ factors were women, whereas 59% of the group with two to four adverse SDZ factors were women. In addition, smoking, current or within the past year, was more common in the group with two to four adverse SDH factors compared with those without (19% vs. 12%).

Commenting on the measures needed to reduce the future burden of stroke, Professor Steenbrandt Sunnerhagen explains: “With the number of people affected by stroke in Europe projected to increase by 27% from 2017 to 2047, the need for effective interventions becomes never relevant. In light of our findings, targeted strategies are needed. Policymakers, for example, should develop legislation and approaches that take into account the specific circumstances and needs of different communities, while clinicians should consider identifying patients with adverse risk factors for stroke to prevent mortality after stroke.".

"Addressing these disparities will not only support principles of equity in health care, but also has the potential to significantly improve public health outcomes."