Neighborhood socioeconomic status and stroke mortality Disentangling individual and area effects.
Abstract
Socioeconomic status (SES) is a multidimensional concept comprising a variety of interacting factors that influence health in a dynamic manner over the entire lifespan. When looking at its association with health, the quasi-universal pattern is that of increasing level of morbidity as SES decreases, and stroke is no exception.1,2 In the last 3 decades evidence has accumulated showing how both individual and neighborhood SES independently affect stroke incidence.3–6 A combination of adverse lifestyle factors, detrimental physical and social environments, and perhaps lower access to primary health care are likely to contribute to this excess risk. Several studies, including that of Brown et al.7 in this issue of Neurology®, have looked at survival poststroke as a function of SES. This question is of importance; are the consequences of stroke also borne disproportionately by the poor the way that stroke occurrence is?