Avendano M et al. (2006) Socioeconomic status and stroke incidence in the US elderly: the role of risk factors in the EPESE study. Stroke 37: 1368–1373

Although low socioeconomic status has been linked with an elevated risk of stroke in European countries, it is unclear how biomedical, psychosocial and physical functioning risk factors influence this association among elderly people in the US. Avendano et al. have used 12-year follow-up data from 2,812 men and women aged 65 years or older in the New Haven cohort of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) study, to investigate the effect of socioeconomic status on the incidence of first nonfatal or fatal stroke in an aging US population.

Among participants aged 65–74 years, those with the lowest levels of education or income were two times more likely to develop incident stroke than individuals with a high socioeconomic status. Adjustment for race, diabetes, depression, social networks and physical functioning reduced the hazard ratios considerably, indicating that these risk factors influence the observed disparities in stroke incidence. Interestingly, a reverse pattern was observed beyond the age of 75 years, with the highest stroke incidence among individuals with the highest socioeconomic status. A possible explanation is that people with a low socioeconomic status die earlier in life than those with a high socioeconomic status, leading to 'selective survival' in old age.

The authors conclude that to reduce the increased burden of stroke among disadvantaged groups in aging populations, improving the management of diabetes and depression, as well as maintaining social networks and physical functioning, will be important.