Abstract TP225: Socioeconomic Status And Etiologies Of Ischemic Stroke In Peru

Abstract

Background: Studies have reported an association between lower socioeconomic status (SES) and an elevated risk of ischemic stroke. It is unclear whether low SES is correlated with a specific etiology of ischemic stroke. Few studies have investigated the relationship in LMIC nations with wide disparities in SES. We analyzed data from a hospital-based stroke registry in Lima, Peru to determine the association between level of education as an indicator of SES and ischemic stroke etiology. Methods: All patients hospitalized with ischemic stroke at the National Institute of Neurologic Sciences from 2015-2018 were prospectively collected in a registry including demographics, risk factors, highest attained level of education, and diagnosed etiology of stroke by TOAST criteria. Association between ordinal level of education and stroke etiology was assessed after adjusting for differences in demographics and comorbidities by a multinomial multivariate logistic regression model. Results: A total of 461 cases of ischemic stroke were ascertained with 38.4% female and a mean age of 66.2 (SD 13.0). Stroke etiology was composed of 7.5% atherosclerotic, 29.7% cardioembolic, 14.2% small vessel disease, 24.7% cryptogenic, and 24.0% with incomplete evaluation. Higher education level strata had more men, younger mean age, and lower rates of hypertension. After multivariate adjustment, lower level of education was associated with an increased odds of large artery atherosclerosis compared to all non-cardioembolic etiologies (OR=2.27; 95% CI, 1.12-4.55). There was no significant association with level of education and odds of cardioembolic stroke after multivariate adjustment. Conclusion: Lower SES is associated with an increased odds of atherosclerotic etiology in patients with non-cardioembolic ischemic stroke. The associated between SES and stroke may be attributed to a higher burden of atherosclerotic disease in lower SES.