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DOI: 10.1055/s-0037-1606017
Social inequalities in the burden of stroke in Germany: cross-sectional analysis of a nationwide population-based health survey
Publication History
Publication Date:
01 September 2017 (online)
Background:
Knowledge of social inequalities in stroke is important for effective stroke prevention and management.
Purpose:
To examine (1) associations between socioeconomic status (SES) and the prevalence of stroke and (2) the influence of SES on associations between stroke and health outcomes in the general population in Germany.
Methods:
We analysed pooled data from 2009, 2010, and 2012 waves of the nationwide population-based German Health Update (GEDA) study with 62,446 participants aged ≥18 years. Associations between SES and stroke prevalence were examined in logistic regression analyses. Influence of SES on associations between stroke and a range of health outcomes were examined by regression models including interaction terms for SES*stroke.
Results:
The lifetime prevalence of stroke was 2.5% overall, 2.4% in women and 2.6% in men. Prevalence was 1.6% in high SES, 2.4% in medium SES, and 4.1% in low SES groups (p(trend)< 0.001), with similar gradients in all age groups in men and women. Adjusting for sociodemographics, lower SES was associated with a higher prevalence of stroke (OR medium vs. high SES: 1.4 (95% CI 1.2 – 1.6); OR low vs. high SES: 1.9 (1.5 – 2.4)). Adjusting for sociodemographics and comorbidities, participants with a history of stroke more often reported bad or very bad self-rated health (OR 1.9 (1.6 – 2.3)), severe global activity limitations in the last 6 months (OR 1.8 (1.5 – 2.2)), frequent mental distress in the last 4 weeks (OR 1.4 (1.2 – 1.8)), and at least one hospital admission in the last 12 months (OR 1.8 (1.5 – 2.1)), compared to participants without stroke. No differences between SES groups were found for these health outcomes (all p for interaction SES*stroke > 0.1).
Conclusions:
Lower SES is associated with higher stroke prevalence among men and women in Germany. Lifetime history of stroke is associated with poorer health status independently of comorbidities in adjusted analyses, but outcomes did not differ between SES groups.