Mark McAllister, MD

Andersen KK, Dalton SO, Steding-Jessen M, Olsen TS. Socioeconomic Position and Survival After Stroke in Denmark 2003 to 2012: Nationwide Hospital-Based Study. Stroke. 2014

The poor face numerous staggering inequalities, and their health is no exception. Health outcomes by almost every metric are worse for those with lower socioeconomic status, and we know that the incidence of stroke is substantially higher in the poor.The authors of this study investigate the rates of mortality by socioeconomic position.

Individuals over 40 with no history of prior stroke were extracted from the Danish stroke registry leading to a population of over 56,000 patients studied. The authors divided patients by income quintile as well education level. Unsurprisingly patients with the lowest income and education levels suffered more severe strokes and had more preventable risk factors than richer patients. A dramatic relationship between income level and risk of death after stroke was demonstrated as well, and this was intact after adjustment for risk factors. This relationship was not evident with education level.

While the finding that the poorest patients are those most likely to die after stroke does not astonish, it should raise our concern. On a systems level we fail our most vulnerable citizens. This particular study was performed in Denmark, a rich (21st in GDP per capita) industrialized nation with public healthcare. Even so, it appears that the impoverished are set up for poor health outcomes, and often pay with their lives.