Three months after a stroke, those with low education and income levels may be 10% more likely to die or require assistance from others to do everyday chores than those with high education and income levels, according to new research published in Neurology. The study does not establish a link between low income and education and poorer post-stroke outcomes. It merely displays a correlation.
People with low socioeconomic status have been found in prior studies to have greater cardiovascular risk factors for stroke and less access to high-quality stroke care than those with high socioeconomic status “says study author Anita Lindmark, Ph.D., of Umeå University in Sweden.
The purpose of our study was to ascertain if socioeconomic status matters following a stroke. Not only did we discover that those with lower incomes and educational levels had a higher chance of dying young and being dependent on others, but we also discovered that actions aimed at closing the gap might potentially save lives.
In order to conduct the study, researchers looked up 25,846 individuals who had a stroke within two years of each other and who, before the stroke, were able to live their lives without help with everyday tasks like eating, walking, dressing, or taking a bath. 6,798 persons died or required assistance with everyday activities three months after having a stroke.
Participants’ income and educational attainment were then determined by the researchers. They separated education into three levels: elementary, middle school, and university. Income was defined as the participant’s share of their family’s pre-stroke disposable income in the previous year.
Researchers separated individuals into three socioeconomic categories based on these two variables. Merely possessing a primary school education and having disposable income in the lowest category were considered indicators of poor socioeconomic standing. Those in the highest group with a college degree and discretionary income were considered to have a high socioeconomic standing. The group in the middle contained everyone in between.
The chance of dying and needing assistance from others to do everyday duties was then calculated three months following stroke. Among the 4,134 individuals in the low group, 1,619 (or 39%) passed away or became reliant on others. Out of 3,347 individuals in the high group, 591 individuals, or 18%, passed away or became reliant on others.
Researchers discovered that, after controlling for age and sex, those in the lower socioeconomic group had a 10% higher absolute risk of dying and becoming dependent on others than those in the upper socioeconomic group, and a 5% higher absolute risk than those in the intermediate group.
The amount of risk that would still exist if those in the low group received the same co-occurring conditions, the same degree of stroke, and the same stroke treatments—such as blood thinners and surgery—as those in the high group was then examined by researchers through an analysis. Researchers discovered through this analysis that 40% of the elevated risk was eliminated, meaning that individuals in the low group were at a 3% higher risk overall compared to those in the middle group and at a 6% higher risk compared to those in the high group.
“Our research suggests that it could be possible to save 40 out of every 1,000 patients in the low socioeconomic group from dying or becoming dependent on others if we could equalize differences between socioeconomic groups,” Lindmark stated.
A constraint of the research was the lack of comprehensive data regarding the post-stroke medical care that the participants obtained, as well as their adherence to medication regimen. Limited data was also available on other socioeconomic determinants of health, such as the participants’ neighborhoods and place of employment.
Provided by American Academy of Neurology.