title: The influence of neighborhood unemployment on mortality after stroke.
abstract: BACKGROUND
  Few studies have investigated the impact of neighborhood characteristics on mortality after stroke. Aim of our study was to analyze the influence of district unemployment as indicator of neighborhood socioeconomic status (SES-NH) on poststroke mortality, and to compare these results with the mortality in the underlying general population.
  
  
  METHODS
  Our analyses involve 2 prospective cohort studies from the city of Dortmund, Germany. In the Dortmund Stroke Register (DOST), consecutive stroke patients (N=1883) were recruited from acute care hospitals. In the Dortmund Health Study (DHS), a random general population sample was drawn (n=2291; response rate 66.9%). Vital status was ascertained in the city's registration office and information on district unemployment was obtained from the city's statistical office. We performed multilevel survival analyses to examine the association between district unemployment and mortality.
  
  
  RESULTS
  The association between neighborhood unemployment and mortality was weak and not statistically significant in the stroke cohort. Only stroke patients exposed to the highest district unemployment (fourth quartile) had slightly higher mortality risks. In the general population sample, higher district unemployment was significantly associated with higher mortality following a social gradient. After adjustment for education, health-related behavior and morbidity was made the strength of this association decreased.
  
  
  CONCLUSIONS
  The impact of SES-NH on mortality was different for stroke patients and the general population. Differences in the association between SES-NH and mortality may be partly explained by disease-related characteristics of the stroke cohort such as homogeneous lifestyles, similar morbidity profiles, medical factors, and old age.
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany. Electronic address: unrathm@uni-muenster.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Unrath
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wellmann
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Diederichs
authors.affiliation: German Stroke Foundation, Guetersloh, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Binse
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: Marianne
authors.initials: M
authors.lastname: Kalic
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Center, University of Wuerzburg, Wuerzburg, Germany; Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany.
authors.forename: Peter Ulrich
authors.initials: PU
authors.lastname: Heuschmann
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000401:mortality*; D002543:Cerebral Hemorrhage / Q000401:mortality*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012111:Residence Characteristics; D012923:Social Class; D012959:Socioeconomic Factors; D020521:Stroke / Q000401:mortality*; D014478:Unemployment
keywords: Epidemiology of stroke; TIA; hemorrhagic stroke; ischemic stroke; mortality; neighborhood deprivation; socioeconomic status; unemployment