Socioeconomic Status and Stroke

Abstract

Background: Stroke has been shown to disproportionately strike those of lower income, either inhabitants of low-income countries, or low-income groups within high-income countries. Norway is a social democratic welfare state where every citizen has the same access to health care services, including acute stroke treatment. The aim of this prospective study was to assess if stroke severity and short-term functional outcome is affected by socioeconomic status (SES). Methods: All ischemic stroke patients admitted to the stroke unit at Haukeland University Hospital, Norway, between February 2006 and December 2008 were sent a questionnaire 6 months after stroke ictus. The questionnaire included information regarding SES as well as subjective opinion of quality of life post stroke. SES data was self-reported and included gender, age, marital status, education, individual net income and occupation. Stroke severity was determined by use of National Institutes of Health Stroke Scale Score (NIHSS) on admission and short-term functional outcome was defined using the modified Rankin Scale (mRS) score on day 7 after ictus. NIHSS and mRS were dichotomized in high/low depending on their mean values; respectively NIHSS score ≤ 6 / > 6 and mRS score ≤ 2 / > 2. Logistic regression was chosen for multivariate analysis and SES factors (income, education and marital status) were forced into all regression models. Results: A total of 328 patients with ischemic stroke were included in the study; mean age was 67.7 years (SD 13.3) at the time of stroke ictus, and 63 % were male. Patients with a high net income were more often married ( P < .01 ) than those of lower income, and as expected, had a higher level of education ( P < .001 ). On logistic regression analysis lower net income level was the only SES factor associated with a more severe stroke (OR = 0.64, 95 % CI 0.44 - 0.92, P = 0.02). SES did not affect shortterm functional outcome. Conclusion: Preliminary results show that lower net income predicts a more severe stroke. This was found in a Norwegian stroke population despite equal access to health care services and free education for all citizens.