Income inequalities and stroke mortality trends in Sao Paulo, Brazil, 1996-2011

It is not clear the relationship between stroke mortality trends and socioeconomic inequalities in low- and middle-income countries.

We compared differences of trends in stroke mortality by socioeconomic status in the city of Sao Paulo, Brazil.

We analyzed the intra-urban distribution of stroke death rates from 1996 to 2011 for persons aged 35-74 years old according to income using joinpoint regression.

We confirmed 77 848 stroke deaths in the period, 51·4% of them among persons aged 35-74 years old. For all areas, there was parallelism between genders, and the average annual percent changes combined was -5·2 (-5·7 to -4·6) from 1996 to 2005 and -3·0 (-4·3 to -1·7) from 2005 to 2011. The full period average annual percent changes of age-adjusted rates between persons living in the high- and low-income area were, respectively, -5·4 and -4·2 (P = 0·002) for men and -5·9 vs. -4·9 (P = 0·017) for women. Differences in the risk of stroke between the high- and low-income areas increased more than twofold in the period in both genders.

The risk of stroke death is decreasing in all regions, but the faster decline in mortality rates in the wealthiest area contributes to further greater inequalities.