Trends in the Association of Neighborhood Socioeconomic Status With Stroke Incidence and Mortality From 2000 to 2022: A Population-Based Study.

BACKGROUND

Poverty is associated with increased stroke risk. It is unclear how this has changed over time. We evaluated temporal trends in stroke incidence and 30-day poststroke mortality by neighborhood socioeconomic status (nSES) from 2000 to 2022.

METHODS

All ischemic and hemorrhagic strokes from a population-based stroke surveillance study in Nueces County, Texas from 2000 to 2022 were ascertained and geocoded to census tracts. A composite nSES score was assigned to each tract for each year using data from the US Census Bureau and American Community Survey. Incidence rates at the group level were estimated using Poisson regression. Model 1 included annual nSES percentile, age, sex, and ethnicity. Model 2 added nSES-time, age-time, and ethnicity-time interactions. Trends in 30-day mortality at the individual level were evaluated similarly using multivariable logistic regression, adjusting for clinical and sociodemographic factors.

RESULTS

A total of 5536 stroke cases occurred during the study period and were successfully geocoded. Poorer nSES was associated with greater stroke incidence (incidence rate ratio for 10th versus 90th percentile nSES, 1.37 [95% CI, 1.22-1.54]) at the group level. The magnitude of this association changed over time (nSES*time interaction P value=0.019), fluctuating without a consistent unidirectional trend. Thirty-day mortality at the individual level was not associated with nSES (10th versus 90th percentile adjusted odds ratio, 0.96 [95% CI, 0.70-1.43]) and changes in mortality over time did not differ by nSES (no significant nSES-time interaction).

CONCLUSIONS

Residents of poorer neighborhoods had an excess risk of incident stroke that fluctuated in magnitude over time. Ongoing stroke prevention efforts are needed, particularly among residents of low SES neighborhoods.