Abstract P310: Socioeconomic Inequalities In The Incidence Of Cerebrovascular Accident And Subtypes Among Migrant Groups In The Netherlands: Analysis Of Nation-wide Data
Background: Inverse relationship between socio-economic status (SES) and the incidence of stroke has been well demonstrated in the industrialized countries. However, this inverse relationship is mainly observed in the majority host population, with earlier studies showing no relation or positive relationship in migrant populations. The general consensus is that socioeconomic inequalities will eventually emerge. This study sought to assessed the current state of socioeconomic inequalities in relation to cerebrovascular accident (CVA) and subtypes (subarachnoid haemorrhage, intracerebral haemorrhage, and ischemic stroke) incidence among major migrant populations in the Netherlands.
Methods: A nationwide register-based cohort study was conducted (n=2,641,451 persons) between January 1st 1998 and December 31st 2010 among migrant groups originating from Suriname, Netherlands Antilles, Indonesia, Morocco and Turkey. Standardized household disposable income was used a as proxy for socioeconomic position. Cox proportional hazard models were used to estimate the socioeconomic inequalities in stroke incidence.
Results: The incidence of total CVA and all the CVA subtypes were higher in the low-income group than in the high-income group among majority Dutch population. Similar observations were also found among most migrant groups especially among migrants with long migration histories such as Suriname-born and Indonesia-born in whom individuals with low-income consistently had a higher risk of total CVA and all the CVA subtypes: age, sex, and Charlson Index adjusted hazard ratio (aHR) for total CVA was 1.36 (95% CI, 1.17-1.61), and CVD subtypes ranging from 1.45 (95% CI, 1.22-1.73) for ischemic stroke to 1.94 (95% CI, 1.35-2.78) for subarachnoid haemorrhage in Surinamese; and aHR for total CVA was 1.15 (1.03-1.28) and CVA subtypes ranging from 1.21 (95% CI, 1.02-1.44) for intracerebral haemorrhage to 1.26 (95% CI, 1.04-1.53) for subarachnoid haemorrhage in Indonesians. In general, the risk of CVA was higher in all SES groups in migrants from Suriname, Indonesia and Antilles, but lower in migrants from Morocco compared with the Dutch general population.
Conclusion: Our findings demonstrate socioeconomic inequalities in CVA incidence in most migrants groups and suggest a convergence towards the Dutch general population. Reduction in CVA incidence in poor sections of the migrant groups would represent a major public health improvement for all ethnic groups.
Author Disclosures: C. Agyemang: None. L. van Oeffelen: None. M. Bots: None. K. Stronks: None. I. Vaartjes: None.
- © 2014 by American Heart Association, Inc.