Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers

Camila Pantoja-Ruiz; Rufus Akinyemi; Diego I. Lucumi-Cuesta; Daniel Youkee; Eva Emmett; Marina Soley-Bori; Wasana Kalansooriya; Charles Wolfe; Iain J. Marshall

doi:10.1161/STROKEAHA.124.049474

Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers

Camila Pantoja-Ruiz^*, Rufus Akinyemi, Diego I. Lucumi-Cuesta, Daniel Youkee, Eva Emmett, Marina Soley-Bori, Wasana Kalansooriya, Charles Wolfe, Iain J. Marshall

^*Corresponding author for this work

Population Health Sciences

Research output: Contribution to journal › Review article › peer-review

7 Citations (Scopus)

Abstract

The latest research on socioeconomic status (SES) and stroke continues to demonstrate that individuals with low SES are at a higher risk of stroke, receive lower-quality care, and experience poorer outcomes. Despite growing evidence on the impact of SES on stroke, gaps remain in understanding the underlying mechanisms and the influence of SES in different contexts, particularly in low- and middle-income countries. This narrative review builds upon our previous reviews from 2006 to 2015, focusing on studies published since 2015 to update on the influence of SES on stroke. Reports from nationwide or population-based observational studies in the past decade have confirmed that these inequalities persist globally and have provided new evidence on their mechanisms. In high-income countries, inadequate control of cardiovascular risk factors (hypertension, diabetes, obesity, and dyslipidemia) among lower socioeconomic groups has been found to explain much of the inequality in stroke risk. Exposure to particulate air pollution (both environmental and indoor from solid fuel cooking) synergizes with cardiovascular risk factors, especially hypertension, as major causes in low- and middle-income countries. Lower SES is persistently associated with disparities in care and increased poststroke disability and mortality. Lower SES also exacerbates other causes of health inequality among women, ethnic minorities, and migrants. Addressing stroke inequalities requires an interdisciplinary approach. Targeting cardiovascular risk factors, providing equitable quality of acute and rehabilitative stroke care, enacting legislative measures, and implementing societal changes remain leading global priorities.

Original language	English
Journal	Stroke
DOIs	https://doi.org/10.1161/STROKEAHA.124.049474
Publication status	Accepted/In press - 2024

Keywords

hypertension
mortality
risk factors
social class
stroke

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/STROKEAHA.124.049474

Cite this

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title = "Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers",

abstract = "The latest research on socioeconomic status (SES) and stroke continues to demonstrate that individuals with low SES are at a higher risk of stroke, receive lower-quality care, and experience poorer outcomes. Despite growing evidence on the impact of SES on stroke, gaps remain in understanding the underlying mechanisms and the influence of SES in different contexts, particularly in low- and middle-income countries. This narrative review builds upon our previous reviews from 2006 to 2015, focusing on studies published since 2015 to update on the influence of SES on stroke. Reports from nationwide or population-based observational studies in the past decade have confirmed that these inequalities persist globally and have provided new evidence on their mechanisms. In high-income countries, inadequate control of cardiovascular risk factors (hypertension, diabetes, obesity, and dyslipidemia) among lower socioeconomic groups has been found to explain much of the inequality in stroke risk. Exposure to particulate air pollution (both environmental and indoor from solid fuel cooking) synergizes with cardiovascular risk factors, especially hypertension, as major causes in low- and middle-income countries. Lower SES is persistently associated with disparities in care and increased poststroke disability and mortality. Lower SES also exacerbates other causes of health inequality among women, ethnic minorities, and migrants. Addressing stroke inequalities requires an interdisciplinary approach. Targeting cardiovascular risk factors, providing equitable quality of acute and rehabilitative stroke care, enacting legislative measures, and implementing societal changes remain leading global priorities.",

keywords = "hypertension, mortality, risk factors, social class, stroke",

author = "Camila Pantoja-Ruiz and Rufus Akinyemi and Lucumi-Cuesta, {Diego I.} and Daniel Youkee and Eva Emmett and Marina Soley-Bori and Wasana Kalansooriya and Charles Wolfe and Marshall, {Iain J.}",

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doi = "10.1161/STROKEAHA.124.049474",

language = "English",

journal = "Stroke",

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AU - Pantoja-Ruiz, Camila

AU - Akinyemi, Rufus

AU - Lucumi-Cuesta, Diego I.

AU - Youkee, Daniel

AU - Emmett, Eva

AU - Soley-Bori, Marina

AU - Kalansooriya, Wasana

AU - Wolfe, Charles

AU - Marshall, Iain J.

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AB - The latest research on socioeconomic status (SES) and stroke continues to demonstrate that individuals with low SES are at a higher risk of stroke, receive lower-quality care, and experience poorer outcomes. Despite growing evidence on the impact of SES on stroke, gaps remain in understanding the underlying mechanisms and the influence of SES in different contexts, particularly in low- and middle-income countries. This narrative review builds upon our previous reviews from 2006 to 2015, focusing on studies published since 2015 to update on the influence of SES on stroke. Reports from nationwide or population-based observational studies in the past decade have confirmed that these inequalities persist globally and have provided new evidence on their mechanisms. In high-income countries, inadequate control of cardiovascular risk factors (hypertension, diabetes, obesity, and dyslipidemia) among lower socioeconomic groups has been found to explain much of the inequality in stroke risk. Exposure to particulate air pollution (both environmental and indoor from solid fuel cooking) synergizes with cardiovascular risk factors, especially hypertension, as major causes in low- and middle-income countries. Lower SES is persistently associated with disparities in care and increased poststroke disability and mortality. Lower SES also exacerbates other causes of health inequality among women, ethnic minorities, and migrants. Addressing stroke inequalities requires an interdisciplinary approach. Targeting cardiovascular risk factors, providing equitable quality of acute and rehabilitative stroke care, enacting legislative measures, and implementing societal changes remain leading global priorities.

KW - hypertension

KW - mortality

KW - risk factors

KW - social class

KW - stroke

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DO - 10.1161/STROKEAHA.124.049474

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ER -

Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers

Abstract

Keywords

UN SDGs

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