title: Socioeconomic inequalities in stroke incidence among migrant groups: analysis of nationwide data.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.). c.o.agyemang@amc.uva.nl.
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Aloysia A
authors.initials: AA
authors.lastname: van Oeffelen
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Catharina J M
authors.initials: CJ
authors.lastname: Klijn
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.v.O., M.L.B., I.V.); Section of Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark (M.N.); Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Ilonca
authors.initials: I
authors.lastname: Vaartjes
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D054525:Minority Health; D009426:Netherlands / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology; D014171:Transients and Migrants / Q000706:statistics & numerical data*
keywords: Netherlands; epidemiology; ethnicity; migration; minority groups; minority health; stroke