Correlation Between Stroke And Socioeconomic Status Essay Examples

Introduction

Ranked as the 7th leading factor of disability-adjusted life years lost in 2002, stroke accounts for approximately 10% of all deaths in the world. By 2030, it is expected to become the sixth leading cause of disability (Addo et al., 2012). Research shows that a whopping 16 million first-ever strokes took place in 2005, and 5.7 million deaths occurred due to stroke. 87% of these strokes took place in low and middle income countries. Stroke is the second most common cause of death in the developed countries. By 2015 and 2030, the number of first-ever strokes is expected to escalate to 18 million and 23 million, respectively (Addo et al., 2012). Stroke will become the second leading cause of death and one of the five leading causes of disability by 2030 in the world, and this sharp increase in stroke mortality will affect the lower and middle income countries more rapidly than high income countries because of an increasing level of risk factors and the lack of easy availability of acute care and primary prevention programs. Aside from the higher rate of prevalence of strokes in low socioeconomic belts, another factor that is found to be related to the incidence of stroke is obesity. Indeed, obesity not only debilitates the health by increasing the chances of a number of diseases like cancer, high blood pressure, diabetes, and cardiovascular disease, it can only trigger stroke. This paper would discuss the correlation of stroke with obesity and low socioeconomic condition in greater detail, touching upon the statistics of stroke incidence and several studies as evidence to establish the claim.

Stroke and Its Incidence in the USA - Statistics

A stroke happens when the blood flow of an area of the brain is suddenly cut off. Due to the disconnection of blood flow, the brain cells in the affected area are deprived of oxygen as a result of which they begin to die. If the brain cells begin to die from stroke, the brain functioning of the affected area gets affected, leading to disability such as loss of memory, blindness, and partial or full body paralysis (NSO, 2014). The data released by the American Heart Association show that in the USA, stroke is the 4th leading cause of death that kills about 129,000 people every year. Worldwide, the number of deaths caused by stroke per 100,000 people dropped between 1990 and 2010, but the number of people affected by the first-ever and recurrent strokes each year has gone up substantially in recent years, reaching 33 million in 2010 (AHA, 2014). It is estimated that stroke kills one person in the USA every four minutes, with at least one stroke taking place every 40 seconds. 1 out of every 20 deaths is caused by stroke in the USA (AHA, 2014). Stroke is a leading cause of disability in the country. African-Americans are facing the risk of a first-ever stroke two times more than their white counterparts. African Americans also have a higher rate of deaths from stroke.

Obesity and Stroke

In the study conducted by the American Heart Association for evaluating the 7 key factors responsible for cardiovascular disease and stroke, overweight and obesity were found to be one of the contributing factors to the increase of stroke risks. Since the majority of Americans over the age of 20 years are either overweight or obese, the number of Americans facing the risks of obesity related diseases like heart disease, stroke, high blood pressure, and diabetes is on the rise (AHA, 2014). A meta-analysis of 25 prospective group studies of 2.3 million participants indicated a direct relation between obesity and overweight and stroke. As per the meta-analysis, overweight increases the risk of ischemic stroke by 22% and obesity by 64% (HSPH, 2014).
According to a study published in the Journal of the American Heart Association, Stroke, there is a correlation between a person's degree of obesity and his likelihood to suffer from stroke. The study conducted by Dr. Hiroshi Yatsuya and his colleagues involved observing 13,549 middle-aged black and white men and women in four US communities for a period between 1987 and 2005 (Folsom et al, 2010). At the time of starting the study, the participants were free of any cardiovascular disease and cancer. At the end of the follow-up period of 19 years, the study came up with the finding that stroke is highly related to a person's degree of obesity. Regardless of sex and race, the more obese a person is, the higher the chances for him or her to suffer from stroke. Though the incidence rate varied among blacks and whites with black obese people being more prone to stroke than obese whites, the connection between obesity and higher risk of stroke was, however, undeniably obvious.
In order to measure the correlation of obesity with stroke, the BMI, waist to hip ratio, and waist circumference of the subjects were taken into account. People falling under the category of highest BMI suffered from the risk of stroke by 1.43 to 2.12 times more in comparison with the lowest BMI category. Taking waist circumference into account for measuring the risk of stroke, the risk ratios varied from 1.65 to 3.19 and when waist to hip ratio was taken into consideration, the risks hovered between 1.69 and 2.55 (Folsom et al, 2010). Thus, it was found that highly obese people had two times higher risk of stroke in comparison with people belonging to lowest categories in any obesity parameter.

Low Socioeconomic Condition and Stroke

The relationship between health and socioeconomic status is not new. Several studies over the last 150 years have substantiated a correlation between the two. A person of low socioeconomic status is likely to have poor health condition than his wealthy counterpart. The connection between stroke and socioeconomic status has been studied by researchers, and they have all found a correlation between the two. The prevalence of stroke is found to be higher in low socioeconomic groups, which have greater stroke severity and lower rate of survival (Brown et al, 2005). The connection between stroke and the socioeconomic status is likely to be influenced by different factors, including income, level of education, occupation, ownership of home and goods, and area-based deprivation indices (Cox et al., 2006). It has been observed that the lifestyle led by people belonging to lower socioeconomic status contributes to their higher risk of stroke in comparison with the people of higher income groups. A study conducted by the National Health and Nutrition Examination Survey (NHANES) in the USA shows that both men and women pertaining to lower income social strata increasingly engage in stroke-increasing lifestyle practices such as smoking, alcoholism, lack of physical activity, and the use of blood pressure lowering drugs (Cox et al., 2006).
In the USA, Western Europe, and Japan, stroke shares an inverse relationship with socioeconomic status as the age of people increases. A study conducted in the 1980s on the relationship between stroke and socioeconomic inequalities showed that the rate of mortality from stroke is higher in people with manual occupations across all ages and low in non-manual sections in Norway, England, France, Finland, and Portugal. The study also reveals that the risk ratio of stroke is 4.23 times higher in the manual occupational class than the non-manual class (Braig et al, 2011). Another study conducted in the 1990s on the rate of stroke mortality in terms of educational level in 10 European countries revealed that the mortality rate was higher among people educated below upper secondary level or equivalent. A large group study conducted in the USA in the period between 1984 and 1997 shows that the rate of mortality from stroke is 2.25 times higher in men in lower socioeconomic groups than that of the highest socioeconomic group, and the same for women is 1.53 times higher (Cox et al., 2006).
A higher rate of stroke risk has been observed in the southeastern states, including Alabama, South Carolina, Tennessee, North Carolina, Arkansas, Oregon, Oklahoma, Mississippi, Louisiana, Virginia, Georgia, and Kentucky in the USA compared to other regions of the country. Due to the high prevalence of stroke, the southeastern states are called the Stroke Belt. A study was conducted by Dr. Liao and his colleagues (2009) to find out the reasons for the disparity of stroke prevalence in the southeastern states with the rest of the country. The study result reveals that although both the Stroke Belt and the non-Stroke Belt had a similar distribution of people based on age and sex, the Stroke Belt had a relatively lower proportion of older adults. However, the number of black residents in the Stroke Belt was higher than the non-Stroke Belt. Residents of the Stroke Belt had lower levels of education and had lower levels of income. The prevalence rate of smoking, obesity, diabetes, hypertension and coronary heart disease was higher in the Stroke Belt than the non-Stroke Belt. The number of deaths due to stroke reported in the southeastern states has been consistently higher than the non-Stroke Belt over the last 50 years. The study also shows that about one third (33%) of the excess prevalence of stroke is the result of socioeconomic disparity alone and other chronic diseases (Liao et al., 2009). Therefore, Liao and his group came to the conclusion that the socioeconomic status influences the risks of stroke considerably.

Conclusion

Stroke is the second most leading cause of death in the USA, and worldwide, it has affected more than 33 million people. It has been ranked as the 7th leading cause of disability in the world. A number of factors influence the prevalence of stroke, with obesity and the socioeconomic status being two of them. Obesity, which contributes to an array of health problems, including heart disease, hypertension, and diabetes, is found to be correlated with higher prevalence of stroke. The study conducted by Yatsuya and his group shows that people with high BMI are from 1.43 to 2.12 times more likely to suffer from stroke. Similar correlation is found between low socioeconomic condition and stroke. Stroke shares an inverse relationship with socioeconomic status as a person ages. It has been found out in several studies that people pertaining to the lower social income group are more likely to live a stroke-inducing life style through smoking, alcoholism, and lack of physical activity. They also suffer more from chronic health conditions such as high blood pressure and diabetes, and all these put together increase their chances of stroke a lot. Studies also show that people involved in manual occupations and with low academic level are also at greater risk of stroke. Taking into account the studies discussed in the paper, a conclusion can be made that both obesity and low socioeconomic status play an important role in the high incidence and prevalence of stroke in the world.

References

Liao, Y., Greenlund, K., Croft, J., Keenan, N., and Giles, W. (2009). Factors Explaining Excess Stroke Prevalence in the US Stroke Belt. Stroke, 40(10), 3336-3341. doi:10.1161/strokeaha.109.561688
Addo, J., Ayerbe, L., Mohan, K., Crichton, S., Sheldenkar, A., and Chen, R. et al. (2012). Socioeconomic Status and Stroke: An Updated Review. Stroke, 43(4), 1186-1191. doi:10.1161/strokeaha.111.639732
Brown, P., Guy, M., and Broad, J. (2005). Individual socio-economic status, community socio-economic status and stroke in New Zealand: A case control study. Social Science & Medicine, 61(6), 1174-1188. doi:10.1016/j.socscimed.2005.02.003
Braig, S., Peter, R., Nagel, G., Hermann, S., Rohrmann, S., and Linseisen, J. (2011). The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort. BMC Public Health, 11(1), 104. doi:10.1186/1471-2458-11-104
Cox, A. M., McKevitt, C. Rudd, A. G., and Wolfe, C. D. (2006). Socioeconomic status and stroke. Lancet Neurol. Vol. 6. 181-88.
Folsom, A. R., Yamagishi, K.,North, K. E., Brancati, F. L. and Stevens, J. (2010). Degree of obesity raises risk of stroke, regardless of gender, race. American Heart Association (AHA). Retrieved on 3rd February 2015 from <http://newsroom.heart.org/news/930>
American Heart Association (AHA). (2014). New statistical update looks at worldwide heart, stroke health. Retrieved on 3rd February 2015 from <http://newsroom.heart.org/news/new-statistical-update-looks-at-worldwide-heart-stroke-health>
National Stroke Organization (NSO). (2014). What is stroke?. Retrieved on 3rd February 2015 from <http://www.stroke.org/understand-stroke/what-stroke>
The Harvard School of Public Health Obesity Prevention Source (HSPH). (2014). Obesity Health Risks. Retrieved on 3rd February 2015 from <http://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/health-effects/>