- 作者：Michael Unrath ; MSc&lowast ; ; unrathm@uni-muenster.de" class="auth_mail ; Jü ; rgen Wellmann ; PhD&lowast ; ; Claudia Diederichs ; PhD&lowast ; ; Lisa Binse ; MSc&dagger ; ; Marianne Kalic ; PhD&lowast ; ; Peter Ulrich Heuschmann ; MD&Dagger ; ; § ; ; 鈭?/sup> ; Klaus Berger ; MD&lowast ;
- 关键词：Epidemiology of stroke ; ischemic stroke ; hemorrhagic stroke ; TIA ; mortality ; neighborhood deprivation ; unemployment ; socioeconomic status
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：July 2014
- 年：2014
- 卷：23
- 期：6
- 页码：1529-1536
- 全文大小：238 K
Methods
Our analyses involve 2 prospective cohort studies from the city of Dortmund, Germany. In the Dortmund Stroke Register (DOST), consecutive stroke patients (N = 1883) were recruited from acute care hospitals. In the Dortmund Health Study (DHS), a random general population sample was drawn (n = 2291; response rate 66.9%). Vital status was ascertained in the city's registration office and information on district unemployment was obtained from the city's statistical office. We performed multilevel survival analyses to examine the association between district unemployment and mortality.
Results
The association between neighborhood unemployment and mortality was weak and not statistically significant in the stroke cohort. Only stroke patients exposed to the highest district unemployment (fourth quartile) had slightly higher mortality risks. In the general population sample, higher district unemployment was significantly associated with higher mortality following a social gradient. After adjustment for education, health-related behavior and morbidity was made the strength of this association decreased.
Conclusions
The impact of SES-NH on mortality was different for stroke patients and the general population. Differences in the association between SES-NH and mortality may be partly explained by disease-related characteristics of the stroke cohort such as homogeneous lifestyles, similar morbidity profiles, medical factors, and old age.