One factor reduces the likelihood of death after a stroke by a third: social class | Health and wellness

There are three things in life, the song said. And the two of them are closely related, as science suggests. A good economic level can reduce the likelihood of dying after a stroke by a third, according to new research presented today at the European Stroke Organization conference. The study analyzed data from 6,901 stroke patients in Gothenburg, Sweden, between November 2014 and December 2019 to examine the influence of socioeconomic factors such as area of ​​residence, country of birth, education and income. The results leave no room for doubt: people with high incomes have a 32% lower risk of mortality after a stroke. Additionally, people with higher education have a 26% lower risk of dying after this event. “The results reveal a harsh reality: a person’s socioeconomic level can be a matter of life and death in the event of a stroke,” explains Katharina Sannerhagen, head of the Rehabilitation Medicine Research Group, in an email at the University of Gothenburg. and lead author of the study.

A stroke occurs when blood flow to part of the brain is interrupted or reduced, depriving brain tissue of oxygen. It is the most common cause of death in Spain among women and the second most common among men. According to a recent study published in the journal Lancet Neurology. They had already warned that growth would be uneven, with much more growth in developing countries and little change in rich countries such as Spain.

But why does money play such a decisive role in this move? “We know that wealthier people are more likely to see their family doctor,” explains Sunnerhagen. “It may be that those with lower incomes cannot afford to take time off and lose wages. “In addition, higher income and better training usually mean better eating habits, more physical activity, fewer addictions and less smoking.” All of these, along with age, are the main risk factors for stroke. If someone is injured, the risk of a repeat event increases many times over.

The study was conducted in Sweden, but the author believes the results can be extrapolated to the rest of Europe, “where similar healthcare structures and levels of social vulnerability exist.” This, he explains, highlights “a widespread problem across the continent.” Marie Mar Freijo, coordinator of the SEN Cerebrovascular Research Group, agrees. And he points to the latest NHS Annual Report, which notes that “there is a social gradient for cerebrovascular disease, with prevalence increasing as income levels decrease.” Social context as well as economic and educational level are determining factors when it comes to experiencing this event. “The same thing happens when you have a stroke,” he adds in a phone conversation. “Control of risk factors is very important to prevent recurrence of these events.”

Freijo is positive about the study and believes it adds more evidence to an idea that has gained traction in recent years. Cerebrovascular events are largely determined by our lifestyle. This has a negative effect: inequality and poverty become determining factors. But this also has a positive side, since these diseases can largely be prevented through prevention. “Policies aimed at promoting health and primary prevention so that a vascular event does not occur are very important,” says the neurologist.

In addition to finding a significant association between income and risk of mortality after stroke, the study points to a troubling trend regarding the cumulative impact of social determinants of health. These determinants, according to WHO, “are the circumstances in which people are born, grow, work, live and age.” Its context. In the present study, the risk of mortality in patients with any social disadvantage was 18% higher than in patients without any social disadvantage. This risk increased to 24% in patients with two to four adverse social factors. When analyzing risk factors, it is necessary to consider not only cholesterol levels, alcohol consumption or smoking, but also zip code.

When examining gender differences and the potential impact of risk factors, it was observed that the proportion of women increased with the number of adverse social factors; In the group with no adverse social factors, 41% were women, while in the group with two to four adverse social factors, 59% were women. “It increased significantly,” says Sunnerhagen, “and this is one of the most interesting results.” Social inequality that leads to increased health risks.

Finally, the study notes that it is critical to have specific strategies in place. “For example, policymakers must adapt legislation and approaches to take into account the specific circumstances and needs of different communities,” explains one of the authors in a related article. “While clinicians should consider identifying patients with adverse social factors.” In this sense, they lead by example. In Sweden, the incidence of ischemic stroke has decreased, so the number of strokes is lower despite the larger population. “It has to do with prevention, with low smoking rates in the country, with controlled hypertension, with good treatment of diabetes… And also with a reduction in the number of sedentary people,” explains Dr. Sunnerhagen. In this sense, he adds that the only risk factor that cannot be controlled is age, and that despite social conditions and external factors, this disease must begin to be treated through prevention. “The best stroke is the one you can’t survive.”

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