Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
Epidemiology. 2011 Mar;22(2):162-9. doi: 10.1097/EDE.0b013e31820463a3.
Data linking neighborhood socioeconomic status (SES) to stroke risk are scarce. We examined long-term stroke incidence according to neighborhood SES in a population-based cohort of patients hospitalized with first myocardial infarction (MI).
Consecutive patients aged 65 years or less, discharged from 8 hospitals in central Israel after incident MI in 1992-1993, were followed for stroke through 2005. Individual demographic, socioeconomic, and clinical data were obtained at study entry. We estimated neighborhood SES through a composite census-derived index developed by the Israel Central Bureau of Statistics.
During a median follow-up of 13 years, 196 incident ischemic strokes occurred in 1410 patients. Accounting for death as a competing risk, patients residing in disadvantaged neighborhoods had higher rates of ischemic stroke (cumulative survival estimates: 81%, 88%, and 89% in increasing tertiles of neighborhood SES). Upon multivariable adjustment for individual SES measures (including income, education, and employment), cardiovascular risk factors, MI characteristics and severity indices, and acute management, the overall hazard ratio for stroke in the lower versus upper tertile of neighborhood SES was 1.5 (95% confidence interval [CI] = 1.0-2.3); after 13 years, the adjusted absolute risk difference was 7.9 incident stroke cases per 100 participants with MI (95% CI = 1.7-14.1).
Poor neighborhood SES is associated with increased risk of ischemic stroke post-MI. The association is only partly attributable to individual SES and other baseline characteristics. The potential mechanisms for this association require further study.
将社区社会经济地位（SES）与中风风险联系起来的数据很少。我们在一个基于人群的首次心肌梗死（MI）住院患者队列中，根据社区 SES 检查了长期中风发病率。
1992-1993 年，以色列中部 8 家医院收治的年龄在 65 岁或以下的连续患者因 MI 住院，通过 2005 年随访中风情况。在研究开始时，获得了个体人口统计学、社会经济和临床数据。我们通过以色列中央统计局开发的综合人口普查衍生指数来估计社区 SES。
在中位随访 13 年期间，1410 名患者中有 196 例发生缺血性中风。考虑到死亡是一种竞争风险，居住在弱势社区的患者中风发生率较高（累积生存估计值：社区 SES 递增三分位数的 81%、88%和 89%）。在对个体 SES 指标（包括收入、教育和就业）、心血管风险因素、MI 特征和严重程度指标以及急性管理进行多变量调整后，下 SES 三分位与上 SES 三分位相比，中风的总体危险比为 1.5（95%置信区间 [CI] = 1.0-2.3）；13 年后，调整后的绝对风险差异为每 100 例 MI 参与者中增加 7.9 例中风（95%CI = 1.7-14.1）。
较差的社区 SES 与 MI 后缺血性中风风险增加相关。这种关联部分归因于个体 SES 和其他基线特征。这种关联的潜在机制需要进一步研究。
