Agyemang, Charles3; van Oeffelen, AA4; Nørredam, Marie Louise6; Kappelle, LJ5; Klijn, CJ5; Bots, ML4; Stronks, Karien3; Vaartjes, I4
1 Section of Health Services Research, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet3 Department of Public Health, Academic Medical Center, University of Amsterdam4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht5 Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht6 Section of Health Services Research, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
Analysis of Nationwide Data
Background and Purpose—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. Methods—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. Results—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. Conclusions—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.
Stroke, 2014, Vol 45, Issue 8, p. 2397-2403
Adult; Aged; Female; Humans; Incidence; Male; Middle Aged; Minority Health; Netherlands; Social Class; Socioeconomic Factors; Stroke; Transients and Migrants