Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Trends in Socioeconomic Disparities in Stroke Mortality in Six European Countries between 1981–1985 and 1991–1995
1 Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
2 National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
3 Department of Public Health and Microbiology, Turin University, Turin, Italy.
4 Department of Sociology, University of Helsinki, Helsinki, Finland.
5 Department of Social Sciences, Turin University, Turin, Italy.
6 Medical Statistics, Office for National Statistics, London, United Kingdom.
7 Division for Health Statistics, Statistics Norway, Oslo, Norway.
This study assesses whether stroke mortality trends have been less favorable among lower than among higher socioeconomic groups. Longitudinal data on mortality by socioeconomic status were obtained for Finland, Norway, Denmark, Sweden, England/Wales, and Turin, Italy. Data covered the entire population or a representative sample. Stroke mortality rates were calculated for the period 1981–1995. Changes in stroke mortality rate ratios were analyzed using Poisson regression and compared with rate ratios in ischemic heat disease mortality. Trends in stroke mortality were generally as favorable among lower as among higher socioeconomic groups, such that socioeconomic disparities in stroke mortality persisted and remained of a similar magnitude in the 1990s as in the 1980s. In Norway, however, occupational disparities in stroke mortality significantly widened, and a nonsignificant increase was observed in some countries. In contrast, disparities in ischemic heart disease mortality widened throughout this period in most populations. Improvements in hypertension prevalence and treatment may have contributed to similar stroke mortality declines in all socioeconomic groups in most countries. Socioeconomic disparities in stroke mortality generally persisted and may have widened in some populations, which fact underlines the need to improve preventive and secondary care for stroke among the lower socioeconomic groups.
cerebrovascular accident; Europe; mortality; social class
Abbreviations: ICD-9, International Classification of Diseases, Ninth Revision (ICD-8 and ICD-10 defined analogously).
Correspondence to Mauricio Avendaño, Department of Public Health, Erasmus University Medical Center, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands (e-mail: m.avendanopabon{at}erasmusmc.nl).
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