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Income and education are associated with lower mortality after stroke
Last reviewed: 02.07.2025
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New research presented today at the 10th European Stroke Conference (ESOC) 2024 has found that people with a high income have a 32% lower risk of dying after stroke. In addition, people with a higher level of education have a 26% lower risk of dying after stroke, highlighting the significant differences in stroke survival according to key social determinants of health (SDH).
A registry-based study analyzed data from 6901 stroke patients in Gothenburg, Sweden, from November 2014 to December 2019 to examine the impact of SDZ factors on the risk of mortality after stroke. The study focused on four SDZ factors: area of residence, country of birth, education level, and income.
In addition to finding a significant association between income, education level, and risk of mortality after stroke, the study found a worrying trend regarding the cumulative impact of SDZ factors. Patients with one unfavorable SDZ factor had an 18% higher risk of mortality compared with patients without unfavorable SDZ factors. This risk increased to 24% for patients with two to four unfavorable SDZ factors.
"Our findings highlight the harsh reality that a person's socioeconomic status can be a matter of life and death in the context of stroke, particularly when faced with multiple adverse SCD factors. Although our study was conducted in Gothenburg, we believe that these findings are relevant across Europe, where similar health structures and levels of social vulnerability exist, highlighting a pervasive problem across the continent," said Katerina Steenbrandt Sunnerhagen, professor and lead author of the study, University of Gothenburg, Clinical Neuroscience, Gothenburg, Sweden.
The study also found a link between the increased risk of death and additional risk factors such as physical inactivity, diabetes, alcohol abuse and atrial fibrillation.
Findings regarding gender differences and the potential influence of risk factors are also notable when examining patient characteristics within the study cohort. The proportion of women among patients increased with the number of adverse SDD factors; 41% of the group with no adverse SDD factors were women, whereas 59% of the group with two to four adverse SDD factors were women. In addition, current or past-year smoking was more common in the group with two to four adverse SDD factors compared to those without (19% vs. 12%).
Commenting on the measures needed to reduce the future burden of stroke, Professor Steenbrandt Sunnerhagen explains: “With the number of people affected by stroke in Europe projected to increase by 27% between 2017 and 2047, the need for effective interventions is more urgent than ever. In light of our findings, targeted strategies are needed. Policy makers, for example, should develop legislation and approaches that take into account the specific circumstances and needs of different communities, while clinicians should consider identifying patients with unfavourable SDZ factors to prevent mortality after stroke.”
"Eliminating these disparities will not only support principles of health equity, but also has the potential to significantly improve public health outcomes."