Education-Related Differences in Case Fatality among Elderly with Stroke

Abstract

Background and Purpose: There is strong evidence for the existence of a socioeconomic gradient in stroke incidence and mortality, but there seem to be contradictory findings concerning an association between socioeconomic status and case fatality after stroke. Moreover, there is still a lack of studies that include men and women as well as people over 75 years. Our aim was to investigate whether there were education-related differences in 28-day case fatality after stroke in different age groups. Methods: All patients who were diagnosed with a cerebral infarction at the Umeå University Hospital during a 2-year period were included in this study. Results: In total, 610 stroke patients (331 men, 279 women) aged 20–85 were hospitalized, of whom 77% were first-ever strokes. Overall, there were few education-related differences between the patients in different age groups (20–74 and 75–85 years). The 28-day case fatality after stroke was shown to be associated with a low educational level in patients above 75 years, also after controlling for sex, risk factors and acute stroke care measures. Conclusion: In this population-based study on patients with cerebral infarction, we found an education-related difference in 28-day case fatality in patients aged 75–85 years. The socioeconomic gradient persisted when we adjusted for risk factors and acute care variables. There is a need for more community-based stroke studies including all ages, with good case ascertainment.