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Published on: August 18, 2015
Association between annual household income and adverse outcomes in patients who had ischaemic stroke
Yuhan Zang1, Zhengbao Zhu1, Mengyao Shi2
1Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China.
Insights
Low annual household income increases the risk of poor outcomes after ischemic stroke. This study found a significant association between lower income levels and adverse clinical events within three months post-stroke.
Area of Science:
- Neurology
- Public Health
- Socioeconomics
Background:
- The relationship between socioeconomic status and health outcomes, specifically ischemic stroke prognosis, requires further investigation.
- Previous studies have yielded debatable results regarding the association between annual household income and stroke outcomes.
Purpose of the Study:
- To prospectively examine the association between annual household income and prognosis at 3 months following ischemic stroke.
- To investigate if lower income levels correlate with poorer outcomes after an ischemic stroke.
Main Methods:
- A prospective study included 3975 participants from the China Antihypertensive Trial in Acute Ischemic Stroke.
- Participants were stratified into three income groups: <¥10,000, ¥10,000-19,999, and ≥¥20,000 RMB.
- A meta-analysis combined current findings with previous studies to assess the income-outcome association.
Main Results:
- 1002 participants (25.20%) experienced the primary composite outcome of death or major disability within 3 months.
- After adjustment, low annual household income was linked to a higher risk of the primary outcome (OR 1.60; P=0.034).
- Meta-analysis confirmed a significant association between lower income levels and increased risk of death or major disability post-stroke (pooled RR 1.31).
Conclusions:
- Low annual household income per capita is significantly associated with increased risks of adverse clinical outcomes at 3 months post-ischemic stroke.
- This association appears independent of established stroke risk factors.
- Further research is needed to validate these findings in diverse populations, considering potential limitations like patient exclusion criteria.
Background And Purpose:
The association between annual household income and prognosis of ischaemic stroke remains debatable. We aimed to prospectively investigate the relationship between annual household income and prognosis at 3 months after ischaemic stroke.
Methods:
We included 3975 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. All participants were categorised into three groups according to annual household income per capita: <¥10 000 (Chinese Yuan Renminbi (RMB)), ¥10 000-19 999 and ≥¥20 000. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset, and secondary outcomes included major disability, death, and vascular events. A meta-analysis was conducted to incorporate the results of the current study and previous studies on the association of income level with outcomes after stroke.
Results:
Within 3 months after ischaemic stroke, 1002 participants (25.20%) experienced primary outcome (880 major disabilities and 122 deaths). After multivariate adjustment, low annual household income level was associated with increased risk of the primary outcome (OR 1.60; 95% CI: 1.12 to 2.31; Ptrend=0.034) when two extreme groups were compared. The meta-analysis confirmed the significant association between income level and death or major disability after stroke (pooled relative risk for lowest vs highest income level, 1.31 (95% CI: 1.18 to 1.45)).
Conclusions:
Low annual household income per capita was significantly associated with increased risks of adverse clinical outcomes at 3 months after ischaemic stroke, independently of established risk factors. Further studies from other samples are needed to replicate our findings due to a reason for excluding some patients who had a severe stroke in this study.
Trial Registration Number:
ClinicalTrials.gov (http://wwwclinicaltrialsgov) Registry (NCT01840072).
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