Socioeconomic status and transient ischaemic attack/stroke: a prospective observational study

Cerebrovasc Dis. 2011;31(2):130-7. doi: 10.1159/000321732. Epub 2010 Nov 25.


Background: Lower socioeconomic status (SES) is associated with an increased risk of stroke but the mechanisms are unclear. We aimed to determine whether low-SES stroke/transient ischaemic attack (TIA) patients have a greater burden of vascular risk factors/co-morbidity and reduced health care access.

Methods: We prospectively studied 467 consecutive stroke and TIA patients from 3 Scottish hospitals (outpatients and inpatients) during 2007/2008. We recorded vascular risk factors, stroke severity, co-morbidity measures, investigations and health service utilisation. SES was derived from postcodes using Scottish Neighbourhood Statistics and analysed in quartiles.

Results: TIA/stroke patients in the lowest SES quartile were younger (64 years, SD 14.1) than those in the highest quartile (72 years, SD 12.9; p < 0.0001). They were more likely to be current smokers (42 vs. 22%; p = 0.001) but there was no association with other vascular risk factors/co-morbidity. There was a trend for those with lower SES to have a more severe stroke [modified National Institutes of Health Stroke Scale score and interquartile range: 4 (2-6) vs. 3 (1-5); multivariate p = 0.05]. Lower SES groups were less likely to have neuro-imaging (82 vs. 90%; p = 0.036) or an electrocardiogram (72 vs. 87%; p = 0.003), but differences were no longer significant on multivariate analysis. However, there was equal access to stroke unit care.

Conclusions: Low-SES TIA and stroke patients are younger and have a more severe deficit; an increased prevalence of smoking is likely to be a major contributor. We found equal access to stroke unit care for low-SES patients.

Publication types

  • Multicenter Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Comorbidity
  • Disability Evaluation
  • Female
  • Health Services / statistics & numerical data
  • Health Services Accessibility / statistics & numerical data
  • Hospitals / statistics & numerical data
  • Humans
  • Ischemic Attack, Transient / diagnosis
  • Ischemic Attack, Transient / epidemiology*
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Scotland / epidemiology
  • Severity of Illness Index
  • Smoking / epidemiology
  • Socioeconomic Factors*
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Time Factors
  • Vascular Diseases / epidemiology