Socioeconomic Status and the Risk of Stroke Recurrence in Chinese Patients

Background: The association between socioeconomic status (SES) and the risk of stroke recurrence has been rarely studied, especially in a developing country. Objective: This study aimed to evaluate the association between SES and the risk of stroke recurrence in Chinese stroke patients. Methods: Patients with first-ever ischemic stroke registered in the Nanjing Stroke Registry Program from 2013 to 2015 were enrolled and followed in this study. Information about SES, measured by disposable income and educational level, was collected at baseline. The primary endpoint was defined as fatal or nonfatal recurrent stroke after 7 days of the index stroke. The association between SES and the risk of stroke recurrence was analyzed with multivariate Cox regression model. Results: A total of 2,294 patients with first-ever stroke were included in the study. During a mean follow-up of 2.8 +/- 1.2 years, 298 (13.0%) patients had stroke recurrence. After adjusting for potential confounding factors, compared with patients with a monthly family income of USD >= 1,539, those with an income of USD 769-1,538, USD 462-768, and USD 1-461 had an adjusted hazard ratio (HR) of 1.87 (95% CI 1.11-3.17), 2.40 (95% CI 1.43-4.03), and 2.79 (95% CI 1.65-4.69) for recurrence, respectively. Compared with those with an educational level of >= 13 years, patients with an educational level of 7-12 years and 0-6 years had adjusted HRs of 1.21 (95% CI 0.79-1.86) and 1.73 (95% CI 1.11-2.70), respectively. Conclusions: Chinese stroke patients with lower SES bear higher recurrent risk. These results are suggestive for secondary stroke prevention in Chinese patients.