The following is a summary of “Impact of Poverty on Stroke Recurrence: A Population-Based Study,” published in the May 2024 issue of Neurology by Becker et al.
Researchers conducted a retrospective study examining whether poverty is associated with an increased risk of stroke recurrence after an initial stroke event.
They conducted a population-based study in Greater Cincinnati/Northern Kentucky (2015 to 2018). Incident strokes and recurrences were tracked. The main focus was on neighborhood socioeconomic status (nSES), categorized by poverty levels in four brackets (≤5%, >5%–10%, >10%–25%, >25%). The 2015 American Community Survey data adjusted age, sex, and race to estimate stroke recurrence rates. Cox models analyzed how vascular risk factors impacted recurrence risk by nSES among patients with stroke.
The results showed that 2,125 patients had an incident stroke, and 245 experienced recurrences. Poorer nSES correlated with higher stroke recurrence rates, 12.5, 17.5, 25.4, and 29.9 per 100,000 in areas with ≤5%, >5%–10%, >10%–25%, and >25% below the poverty line, respectively (P<0.01). The relative risk (95% CI) for recurrent stroke among Black vs. White individuals was 2.54 (1.91–3.37) before nSES adjustment and 2.00 (1.47–2.74) post-adjustment, marking a 35.1% decrease. In a secondary analysis, poorer nSES (HR 1.74, 95% CI 1.10–2.76 for lowest vs. highest category) and Black race (HR 1.31, 95% CI 1.01–1.70) were independently associated with recurrence risk, though significance waned after total adjustment. Age, diabetes, and left ventricular hypertrophy were linked to increased recurrence risk in fully adjusted models.
Investigators concluded that Black individuals living in poorer neighborhoods significantly increased the risk of recurrent stroke, with poverty explaining a substantial portion of the higher risk observed.
Source: neurology.org/doi/10.1212/WNL.0000000000209423
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