Skip to main content
AAN.com

Abstract

Objective

To summarize overall patterns of the impact of neighborhood socioeconomic status (nSES) on stroke incidence and uncover potential gaps in the literature, we conducted a systematic review of studies examining the association between nSES and stroke incidence, independent of individual SES.

Methods

Four electronic databases and reference lists of included articles were searched, and corresponding authors were contacted to locate additional studies. A keyword search strategy included the 3 broad domains of neighborhood, SES, and stroke. Eight studies met our inclusion criteria (e.g., nSES as an exposure, individual SES as a covariate, and stroke incidence as an outcome). We coded study methodology and findings across the 8 studies.

Results

The results provide evidence for the overall nSES and stroke incidence association in Sweden and Japan, but not within the United States. Findings were inconclusive when examining the nSES-stroke incidence association stratified by race. We found evidence for the mediating role of biological factors in the nSES-stroke incidence association.

Conclusions

Higher neighborhood disadvantage was found to be associated with higher stroke risk, but it was not significant in all the studies. The relationship between nSES and stroke risk within different racial groups in the United States was inconclusive. Inconsistencies may be driven by differences in covariate adjustment (e.g., individual-level sociodemographic characteristics and neighborhood-level racial composition). Additional research is needed to investigate potential intermediate and modifiable factors of the association between nSES and stroke incidence, which could serve as intervention points.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Marshall IJ, Wang Y, Crichton S, McKevitt C, Rudd AG, Wolfe CD. The effects of socioeconomic status on stroke risk and outcomes. Lancet Neurol 2015;14:1206–1218.
2.
Howard VJ, Kleindorfer DO, Judd SE, et al. Disparities in stroke incidence contributing to disparities in stroke mortality. Ann Neurol 2011;69:619–627.
3.
Kleindorfer D, Khoury J, Moomaw CJ, et al. Stroke incidence is decreasing in whites, but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky stroke study. Stroke 2010;41:1326.
4.
Agyemang C, van Oeffelen AA, Norredam M, et al. Socioeconomic inequalities in stroke incidence among migrant groups: analysis of nationwide data. Stroke 2014;45:2397–2403.
5.
Avendano M, Kawachi I, Van Lenthe F, et al. Socioeconomic status and stroke incidence in the US elderly: the role of risk factors in the EPESE study. Stroke 2006;37:1368–1373.
6.
Cesaroni G, Agabiti N, Forastiere F, Perucci CA. Socioeconomic differences in stroke incidence and prognosis under a universal healthcare system. Stroke 2009;40:2812–2819.
7.
Bray BD, Paley L, Hoffman A, et al. Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England. Lancet Public Health 2018;3:e185–e193.
8.
Bowling A, Stafford M. How do objective and subjective assessments of neighbourhood influence social and physical functioning in older age? Findings from a British survey of ageing. Soc Sci Med 2007;64:2533–2549.
9.
Franzini L, Caughy M, Spears W, Esquer MEF. Neighborhood economic conditions, social processes, and self-rated health in low-income neighborhoods in Texas: a multilevel latent variables model. Soc Sci Med 2005;61:1135–1150.
10.
Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing “neighborhood effects”: social processes and new directions in research. Annu Rev Sociol 2002;28:443–478.
11.
Wen M, Browning CR, Cagney KA. Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Soc Sci Med 2003;57:843–860.
12.
Brown AF, Liang L-J, Vassar SD, et al. Neighborhood disadvantage and ischemic stroke: the cardiovascular health study (CHS). Stroke 2011;42:3363–3368.
13.
Carlsson AC, Li X, Holzmann MJ, et al. Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years: a nationwide cohort study from Sweden. Int J Stroke 2017;12:815–826.
14.
Grimaud O, Béjot Y, Heritage Z, et al. Incidence of stroke and socioeconomic neighborhood characteristics: an ecological analysis of Dijon stroke registry. Stroke 2011;42:1201–1206.
15.
Heeley EL, Wei JW, Carter K, et al. Socioeconomic disparities in stroke rates and outcome: pooled analysis of stroke incidence studies in Australia and New Zealand. Med J Aust 2011;195:10–14.
16.
Honjo K, Iso H, Nakaya T, et al. Impact of neighborhood socioeconomic conditions on the risk of stroke in Japan. J Epidemiol 2015;25:254–260.
17.
Howard VJ, McClure LA, Kleindorfer DO, et al. Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites. Neurology 2016;87:2340–2347.
18.
Yan T, Escarce JJ, Liang LJ, et al. Exploring psychosocial pathways between neighbourhood characteristics and stroke in older adults: the cardiovascular health study. Age and ageing 2013;42:391–397.
19.
Addo J, Ayerbe L, Mohan KM, et al. Socioeconomic status and stroke: an updated review. Stroke 2012;43:1186–1191.
20.
Backholer K, Peters SA, Bots SH, Peeters A, Huxley RR, Woodward M. Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis. J Epidemiol Community Health 2017;71:550–557.
21.
Hedman L, van Ham M. Understanding Neighbourhood Effects: Selection Bias and Residential Mobility. Springer Netherlands; 2011:79–99.
22.
Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health 2001;91:1783–1789.
23.
Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj 2015;350:g7647.
24.
Higgins JP, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions: John Wiley & Sons, 2019.
25.
Littell JH, Corcoran J, Pillai V. Systematic Reviews and Meta-Analysis: Oxford University Press; 2008.
26.
Slavin RE. Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 1995;48:9–18.
27.
World Bank. World Bank Country and Lending Groups [online]. Available at: data.worldbank.org/about/country-and-lending-groups#High_income. Accessed May 19, 2020.
28.
Minh A, Muhajarine N, Janus M, Brownell M, Guhn M. A review of neighborhood effects and early child development: how, where, and for whom, do neighborhoods matter? Health place 2017;46:155–174.
29.
Calling S, Li X, Kawakami N, Hamano T, Sundquist K. Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up. BMC public health 2016;16:634.
30.
Kulick ER, Wellenius GA, Boehme AK, Sacco RL, Elkind MS. Residential proximity to major roadways and risk of incident ischemic stroke in NOMAS (The Northern Manhattan Study). Stroke 2018;49:835–841.
31.
Clark CJ, Guo H, Lunos S, et al. Neighborhood cohesion is associated with reduced risk of stroke mortality. Stroke 2011;42:1212–1217.
32.
Freedman VA, Grafova IB, Rogowski J. Neighborhoods and chronic disease onset in later life. Am J Public Health 2011;101:79–86.
33.
Forsberg P-O, Ohlsson H, Sundquist K. Causal nature of neighborhood deprivation on individual risk of coronary heart disease or ischemic stroke: a prospective national Swedish co-relative control study in men and women. Health Place 2018;50:1–5.
34.
Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Personal Soc Psychol 1986;51:1173.
35.
Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures—the public health disparities geocoding Project. Am J Public Health (1971) 2003;93:1655–1671.
36.
Lovasi GS, Moudon AV, Smith NL, et al. Evaluating options for measurement of neighborhood socioeconomic context: evidence from a myocardial infarction case–control study. Health place 2008;14:453–467.
37.
Anderson NB, Bulatao RA, Cohen B, on Race P, Council NR. What makes a place healthy? Neighborhood influences on racial/ethnic disparities in health over the life course. In: Critical Perspectives on Racial and Ethnic Differences in Health in Late Life: National Academies Press (US); 2004.
38.
Huie B, Hummer RA, Rogers RG. Individual and contextual risks of death among race and ethnic groups in the United States. J Health Soc Behav 2002:359–381.
39.
Shaw G. It's a public health crisis: how systemic racism can Be neurotoxic for black Americans. Neurol Today 2020;20:1–24.
40.
Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol 2015;41:311–330.
41.
Bernstein M, Crosby F. An empirical examination of relative deprivation theory. J Exp Soc Psychol 1980;16:442–456.
42.
Guimond S, Dubé-Simard L. Relative deprivation theory and the Quebec nationalist movement: the cognition–emotion distinction and the personal–group deprivation issue. J Personal Soc Psychol 1983;44:526.
43.
Podder N. Relative deprivation, envy and economic inequality. Kyklos 1996;49:353–376.
44.
Yitzhaki S. Relative deprivation and the gini coefficient. Q J Econ 1979;93:321–324.
45.
U.S. Bureau of the Census. Geographical Mobility: 2010 to 2015 [data File]; 2018.
46.
Andersson E, Abramsson M. Changing residential mobility rates of older people in Sweden. Ageing Soc 2012;32:963.
47.
Sheehan CM, Cantu PA, Powers DA, Margerison-Zilko CE, Cubbin C. Long-term neighborhood poverty trajectories and obesity in a sample of California mothers. Health place 2017;46:49–57.
48.
Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta Mol basis Dis 2016;1862:915–925.
49.
Diez-Roux AV, Merkin SS, Arnett D, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 2001;345:99–106.

Information & Authors

Information

Published In

Neurology®
Volume 96Number 19May 11, 2021
Pages: 897-907
PubMed: 33766995

Publication History

Received: July 15, 2020
Accepted: February 2, 2021
Published online: March 25, 2021
Published in print: May 11, 2021

Permissions

Request permissions for this article.

Disclosure

Y. Kim reports funding from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the US NIH (R03HD101752). E. Twardzik reports funding from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the NIH (F31HD098870, E. Twardzik, PI). S.E. Judd reports funding from the US NIH (1 U01 HL146382, 2 U01 NS041588, 1R01NS09270 1AG 057540, and 5R01HL136666) and the Centers for Disease Control and Prevention 1U01DP006302-01. N. Colabianchi reports funding from the US NIH (R03HD101752, R01HL137731, R01NS092706, R01AG057540, and R01 HL132979). Go to Neurology.org/N for full disclosures.

Study Funding

Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the NIH under award number 1R01NS092706 and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the NIH under award number F31HD098870. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Authors

Affiliations & Disclosures

Yeonwoo Kim, PhD
From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. NIH/NICHD, R03HD101752, Multiple PI, 2020-2022
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Source: National Institutes of Health (F31: NICHD: Individual Pre-Doctoral Fellowship), Grant number: F31HD098870, role: Principal Investigator/Fellow, years: 5/2019 – 5/2021
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Natalie Colabianchi, PhD
From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
University of Alabama, Birmingham, travel costs and speaker honoraria National Collaborative on Childhood Obesity Research, travel costs to participate as speaker on panel
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. NIH R03HD101752, Multiple-PI, 06/01/20 – 03/31/22 2. NIH R01HL137731, PI, 09/01/2017 – 06/30/2021 3. NIH R01NS092706, Multiple-PI, 02/01/2016 – 01/31/2021 4. NIH R01AG057540, Co-Investigator, 09/01/17 – 08/31/21 5. NIH R01 HL132979, Co-Investigator, 09/01/16 – 06/30/21
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Colabianchi, [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Y. Kim and E. Twardzik contributed equally to this work.

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage, Neurology, 102, 3, (2024)./doi/10.1212/WNL.0000000000208039
    Abstract
  2. Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1209446
    Crossref
  3. Cardiovascular Disease in China: Socioeconomic Status Variation in Prevalence, Risk Management and Healthcare Policy, Volume 16, (2077-2084), (2023).https://doi.org/10.2147/RMHP.S429224
    Crossref
  4. Stroke in women between 2006 and 2018: Demographic, socioeconomic, and age disparities, Women's Health, 19, (2023).https://doi.org/10.1177/17455057231199061
    Crossref
  5. The Role of Social Determinants of Health in Cardiovascular Diseases: An Umbrella Review, Journal of the American Heart Association, 12, 13, (2023).https://doi.org/10.1161/JAHA.123.029765
    Crossref
  6. Association between neighborhood socioeconomic status and mechanical thrombectomy for acute ischemic stroke: A nationwide multilevel observational study, Academic Emergency Medicine, 30, 9, (918-926), (2023).https://doi.org/10.1111/acem.14731
    Crossref
  7. Beyond Neighborhood Disadvantage: Local Resources, Green Space, Pollution, and Crime as Residential Community Correlates of Cardiovascular Risk and Brain Morphology in Midlife Adults, Psychosomatic Medicine, 85, 5, (378-388), (2023).https://doi.org/10.1097/PSY.0000000000001199
    Crossref
  8. Neighborhood greenspace and neighborhood income associated with white matter grade worsening: Cardiovascular Health Study, Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 15, 4, (2023).https://doi.org/10.1002/dad2.12484
    Crossref
  9. Socioeconomic factors and stroke, Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 122, 3, (45), (2022).https://doi.org/10.17116/jnevro202212203245
    Crossref
  10. Spatial-temporal analysis of cerebral infarction mortality in Hokkaido, Japan: an ecological study using a conditional autoregressive model, International Journal of Health Geographics, 21, 1, (2022).https://doi.org/10.1186/s12942-022-00316-1
    Crossref
  11. See more
Loading...

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share