Understanding Socioeconomic Disparities in Stroke: an international perspective

The aim of the thesis was to examine the magnitude and explanation of socioeconomic differences in stroke across different world populations. Data from several sources were used including mortality statistics merged with national census data, population cohort studies and general practice registration data. Results indicate that socioeconomic status is associated with higher stroke mortality in many Western populations. Whereas socioeconomic disparities in stroke mortality are similar across Western Europe, there is a north-south gradient in socioeconomic disparities in ischaemic heart disease mortality. Stroke mortality has declined in all socioeconomic groups since the 1980s, but socioeconomic disparities in stroke mortality have persisted during the last decades in Western Europe. Our in-depth studies indicate that socioeconomic differentials in stroke result from the combination of multiple risk factors: Conventional cardiovascular risk factors such as ! hypertension and smoking explain about half of socioeconomic disparities in stroke. Furthermore, psychosocial factors such as depression and social networks additionally contribute to these disparities. Nonetheless, explanations are not uniform in all countries: For instance, whereas smoking plays a major role in explaining stroke disparities in Northern Europe, hypertension seems to be a more prominent factor in Southern European countries. Overall, results indicate that general practitioners provide stroke preventive care of a similar quality to patients from different socioeconomic groups in the Netherlands. Results from this thesis indicate that socioeconomic disparities in stroke are a major public health problem that requires combined interventions and policies. Reducing these disparities is essential to sustain the stroke mortality decline in Western populations.

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