From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
Stroke. 2014 Aug;45(8):2397-403. doi: 10.1161/STROKEAHA.114.005505. Epub 2014 Jun 17.
Low socioeconomic status has been linked to high incidence of stroke in industrialized countries; therefore, reducing socioeconomic disparities is an important goal of health policy. The evidence on migrant groups is, however, limited and inconsistent. We assessed socioeconomic inequalities in relation to stroke incidence among major ethnic groups in the Netherlands.
A nationwide register-based cohort study was conducted (n=2 397 446) between January 1, 1998, and December 31, 2010, among ethnic Dutch and ethnic minority groups. Standardized disposable household income was used as a measure of socioeconomic position.
Among ethnic Dutch, the incidence of stroke was higher in the low-income group than in the high-income group (adjusted hazard ratio, 1.18; 95% confidence interval, 1.16-1.20). Similar socioeconomic inequalities in stroke incidence were found among Surinamese (1.36; 1.17-1.58), Indonesians (1.15; 1.03-1.28), Moroccans (1.54; 0.97-2.43), Turkish (1.19; 0.97-1.46), and to a lesser extent among Antilleans (1.24; 0.84-1.84). When compared with ethnic Dutch, the incidence of stroke was lower in Moroccans, similar in Turkish, but higher in Surinamese among all income groups. The incidence of stroke was higher in Indonesian low- and high-income groups than in their ethnic Dutch counterparts. Among Antilleans, the risk of stroke was higher than ethnic Dutch but only in the low-income group.
Our findings reveal socioeconomic inequalities in stroke incidence among all ethnic groups. Reduction of socioeconomic inequalities in stroke incidence among all ethnic groups may lead to a major public health improvement for all. Policy measures tackling socioeconomic inequalities should take into account the increased risk of stroke among ethnic minority populations.
低社会经济地位与工业化国家的高卒中发病率相关；因此，减少社会经济差距是卫生政策的一个重要目标。然而，有关移民群体的证据有限且不一致。我们评估了荷兰主要族裔群体中与卒中发病率相关的社会经济不平等。
在 1998 年 1 月 1 日至 2010 年 12 月 31 日期间，进行了一项全国范围内基于登记的队列研究（n=2 397 446），包括荷兰族裔和少数民族群体。标准化可支配家庭收入被用作社会经济地位的衡量标准。
在荷兰族裔中，低收入组的卒中发病率高于高收入组（调整后的危险比，1.18；95%置信区间，1.16-1.20）。在苏里南人（1.36；1.17-1.58）、印度尼西亚人（1.15；1.03-1.28）、摩洛哥人（1.54；0.97-2.43）、土耳其人（1.19；0.97-1.46）以及在一定程度上安的列斯人（1.24；0.84-1.84）中，也发现了类似的卒中发病率与社会经济地位相关的不平等。与荷兰族裔相比，摩洛哥人的卒中发病率较低，土耳其人的发病率相似，但所有收入组中苏里南人的卒中发病率较高。在印度尼西亚的低收入和高收入组中，卒中发病率高于荷兰族裔。在安的列斯人组中，卒中风险高于荷兰族裔，但仅在低收入组中如此。
我们的研究结果揭示了所有族裔群体中与卒中发病率相关的社会经济不平等。减少所有族裔群体中与卒中发病率相关的社会经济不平等可能会使所有族裔的公共卫生状况得到重大改善。针对社会经济不平等的政策措施应考虑到少数民族群体卒中风险的增加。
