Higher neighborhood poverty level associated with greater stroke incidence

Key takeaways:

• Stroke incidence rates were highest in neighborhoods with greater poverty.
• The findings “really get at social determinants of health” and factors that lead to the development of neurological diseases.

DENVER — Poorer neighborhood socioeconomic status was associated with greater stroke incidence, according to a poster at the American Academy of Neurology annual meeting.

“It’s well-established that neighborhoods with higher poverty rates have greater stroke incidence,” Christopher J. Becker, MD, an instructor in neurology at the University of Michigan Medical School, told Healio. “The goal of this study was to identify the degree to which that has changed over time.”

Becker and colleagues sought to ascertain any disparities in stroke incidence within neighborhood socioeconomic status (nSES) between 2010 and 2015 in the greater Cincinnati and northern Kentucky region, home to more than 1.3 million persons in a five-county area. The population had previously been included in the Greater Cincinnati Northern Kentucky Stroke Study, which tracked all stroke incidence in the area.

Their study included patients who were hospitalized with their first-ever ischemic or hemorrhagic stroke: 1,968 individuals with incident stroke in 2010 and 2,125 with incident stroke in 2015.

Population estimates were obtained from the United States Census Bureau for both years, via the 5-Year American Community Survey. Home address and incident stroke cases for each patient was geocoded by home address, while socioeconomic status was estimated by the percentage below the poverty line within each census tract.

Researchers employed Poisson regression, adjusted for age, sex and race to determine stroke incidence rates, with an additional nSES-by-year interaction term introduced for evaluation of nSES impact change on stroke incidence between 2010 and 2015.

Overall stroke incidence rates, unadjusted for nSES, did not differ between 2010 and 2015, and adjusted nSES rates per quartile (cases per 100,000) did not differ significantly between study periods, although the 2015 incidence rates were slightly higher than 2010 due to larger sample size, according to the poster.

The greater stroke incidence rates for both the 2010 and 2015 populations occurred in neighborhoods with 10% to 25% and greater than 25% of residents living below the poverty line.

Data additionally showed the association between neighborhood poverty level and increased stroke incidence remained unchanged across the study periods.

“These findings really get at social determinants of health and what are the upstream factors that lead people to develop other neurological diseases,” Becker said. “Poverty is and remains a major risk factor for stroke.”