Poor neighborhood socioeconomic status and risk of ischemic stroke after myocardial infarction.
BACKGROUND
Data linking neighborhood socioeconomic status (SES) to stroke risk are scarce. We examined long-term stroke incidence according to neighborhood SES in a population-based cohort of patients hospitalized with first myocardial infarction (MI).


METHODS
Consecutive patients aged 65 years or less, discharged from 8 hospitals in central Israel after incident MI in 1992-1993, were followed for stroke through 2005. Individual demographic, socioeconomic, and clinical data were obtained at study entry. We estimated neighborhood SES through a composite census-derived index developed by the Israel Central Bureau of Statistics.


RESULTS
During a median follow-up of 13 years, 196 incident ischemic strokes occurred in 1410 patients. Accounting for death as a competing risk, patients residing in disadvantaged neighborhoods had higher rates of ischemic stroke (cumulative survival estimates: 81%, 88%, and 89% in increasing tertiles of neighborhood SES). Upon multivariable adjustment for individual SES measures (including income, education, and employment), cardiovascular risk factors, MI characteristics and severity indices, and acute management, the overall hazard ratio for stroke in the lower versus upper tertile of neighborhood SES was 1.5 (95% confidence interval [CI] = 1.0-2.3); after 13 years, the adjusted absolute risk difference was 7.9 incident stroke cases per 100 participants with MI (95% CI = 1.7-14.1).


CONCLUSIONS
Poor neighborhood SES is associated with increased risk of ischemic stroke post-MI. The association is only partly attributable to individual SES and other baseline characteristics. The potential mechanisms for this association require further study.
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. yarivg@post.tau.ac.il
Yariv
Y
Gerber
Silvia
S
Koton
Uri
U
Goldbourt
Vicki
V
Myers
Yael
Y
Benyamini
David
D
Tanne
Yaacov
Y
Drory
D000328:Adult; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011204:Poverty Areas; D012111:Residence Characteristics; D018570:Risk Assessment / Q000706:statistics & numerical data; D012923:Social Class; D020521:Stroke / Q000453:epidemiology*; D016019:Survival Analysis