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.
Key Words
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Article info
Publication history
Published online: March 03, 2014
Accepted:
December 20,
2013
Received in revised form:
December 17,
2013
Received:
October 29,
2013
Footnotes
Data collection in the Dortmund Health Study was supported by the German Migraine and Headache Society and by unrestricted grants of equal share from Almirall, Astra Zeneca, Berlin Chemie, Boehringer, Boots Health Care, Glaxo-Smith-Kline, Janssen Cilag, McNeil Pharma, MSD Sharp, and Dohme and Pfizer to the University of Muenster. The Dortmund Stroke Register was supported by the Dortmund Stroke Action Group (Schlaganfall-Hilfe Dortmund e.V.). The project received financial support from the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung) within the framework of the research alliance “Health in Old Age” (01ET0723).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.12.038
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
