Education-related differences in case fatality among elderly with stroke.
OBJECTIVE
There is strong evidence for the existence of a socioeconomic gradient in stroke incidence and mortality, but there seem to be contradictory findings concerning an association between socioeconomic status and case fatality after stroke. Moreover, there is still a lack of studies that include men and women as well as people over 75 years. Our aim was to investigate whether there were education-related differences in 28-day case fatality after stroke in different age groups.


METHODS
All patients who were diagnosed with a cerebral infarction at the Umeå University Hospital during a 2-year period were included in this study.


RESULTS
In total, 610 stroke patients (331 men, 279 women) aged 20-85 were hospitalized, of whom 77% were first-ever strokes. Overall, there were few education-related differences between the patients in different age groups (20-74 and 75-85 years). The 28-day case fatality after stroke was shown to be associated with a low educational level in patients above 75 years, also after controlling for sex, risk factors and acute stroke care measures.


CONCLUSIONS
In this population-based study on patients with cerebral infarction, we found an education-related difference in 28-day case fatality in patients aged 75-85 years. The socioeconomic gradient persisted when we adjusted for risk factors and acute care variables. There is a need for more community-based stroke studies including all ages, with good case ascertainment.
Löfmark
Ulrika
U
Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. ulrika.lofmark@fammed.umu.se
Hammarström
Anne
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics* / Q000401:mortality* / Q000523:psychology