Stroke
Volume 45, Issue 8, 2014, Pages 2397-2403

Socioeconomic inequalities in stroke incidence among migrant groups: Analysis of nationwide data (Article) (Open Access)

Agyemang C.* , Van Oeffelen A.A. , Norredam M. , Kappelle L.J. , Klijn C.J.M. , Bots M.L. , Stronks K. , Vaartjes I.
  • a Department of Public Health, Academic Medical Center, University of Amsterdam, 9, 1105AZ Amsterdam, Netherlands
  • b Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
  • c Department of Public Health, Danish Research Centre for Migration Ethnicity, and Health, University of Copenhagen, Copenhagen, Denmark, Section of Infectious Diseases, Department of Immigrant Medicine, Hvidovre Hospital, Copenhagen, Denmark
  • d Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
  • e Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
  • f Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
  • g Department of Public Health, Academic Medical Center, University of Amsterdam, 9, 1105AZ Amsterdam, Netherlands
  • h Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands

Abstract

BACKGROUND AND PURPOSE - : Low socioeconomic status has been linked to high incidence of stroke in industrialized countries; therefore, reducing socioeconomic disparities is an important goal of health policy. The evidence on migrant groups is, however, limited and inconsistent. We assessed socioeconomic inequalities in relation to stroke incidence among major ethnic groups in the Netherlands. METHODS - : A nationwide register-based cohort study was conducted (n=2 397 446) between January 1, 1998, and December 31, 2010, among ethnic Dutch and ethnic minority groups. Standardized disposable household income was used as a measure of socioeconomic position. RESULTS - : Among ethnic Dutch, the incidence of stroke was higher in the low-income group than in the high-income group (adjusted hazard ratio, 1.18; 95% confidence interval, 1.16-1.20). Similar socioeconomic inequalities in stroke incidence were found among Surinamese (1.36; 1.17-1.58), Indonesians (1.15; 1.03-1.28), Moroccans (1.54; 0.97-2.43), Turkish (1.19; 0.97-1.46), and to a lesser extent among Antilleans (1.24; 0.84-1.84). When compared with ethnic Dutch, the incidence of stroke was lower in Moroccans, similar in Turkish, but higher in Surinamese among all income groups. The incidence of stroke was higher in Indonesian low- and high-income groups than in their ethnic Dutch counterparts. Among Antilleans, the risk of stroke was higher than ethnic Dutch but only in the low-income group. CONCLUSIONS - : Our findings reveal socioeconomic inequalities in stroke incidence among all ethnic groups. Reduction of socioeconomic inequalities in stroke incidence among all ethnic groups may lead to a major public health improvement for all. Policy measures tackling socioeconomic inequalities should take into account the increased risk of stroke among ethnic minority populations. © 2014 American Heart Association, Inc..

Author Keywords

Stroke minority health Netherlands ethnicity migration minority groups Epidemiology

Index Keywords

Netherlands Netherlands Antilles minority health lowest income group Stroke health care policy cerebrovascular accident correlation analysis human epidemiology clinical assessment middle aged ethnic group priority journal Aged hazard ratio Confidence interval social status migrant Humans Suriname Minority Groups male female Socioeconomic Factors Indonesia Turk (people) Incidence Article major clinical study adult migration cohort analysis ethnicity Transients and Migrants social class Morocco
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84905378285&doi=10.1161%2fSTROKEAHA.114.005505&partnerID=40&md5=790b23a4ed94868ffe73bc0ce8b02bb2
DOI: 10.1161/STROKEAHA.114.005505
ISSN: 00392499
Cited by: 17
Original Language: English