Wealth Predicts Early Stroke Risk

You don't need a crystal ball to predict a person's risk of having a stroke, just look into the family portfolio. Wealth has been linked to a lower risk of strokes for Americans aged 50 to 64. Not rich? Don't despair. Once you hit the age of 65, the link between financial health and physical health disappears.

The University of Michigan Health and Retirement Study, with findings published in the April issue of Stroke, had researchers analyzing data that examined the effect of education, income, and wealth. Participants aged 50 and older were divided into six groups, based on their level of wealth. They followed this group of almost 20,000 for more than eight years, on average, in which time there were 1,542 strokes. The group of study participants in the poorest 10 percent had a risk of stroke three times greater than those in the richest group. "Wealth is the strongest predictor of stroke among the factors we looked at," said Mauricio Avendano, coauthor of the study.

The study comparisons also found common risk factors for stroke among people aged 50 to 74 who had less wealth, income, or education. These factors included higher rates of high blood pressure, heart disease, diabetes, smoking, low physical activity, and excess weight. Dr. Avendano says that many Americans are not in strong financial shape by the time they hit 50. Without the resources, especially money, to acquire reliable, good quality healthcare, people don't get the regular or preventative care they need. "People put things off," says Claudette Brooks, director of the neurovascular lab at the stroke center at West Virginia University School of Medicine. "They don't seek care until they perceive it as being more serious than when it started."

The study authors note that financial security may affect people's risk in other ways. Psychosocial risk factors such as depression and lack of social support may play a role and are more common among lower socioeconomic groups. The authors say "wealth may increase individuals' sense of control over their lives, reducing psychosocial stress and subsequent stroke risk."

Researchers said the next step in this ongoing study is to research why wealth, income and education don't seem to influence stroke risk after the age of 65. "We expected wealth to be a strong predictor of stroke in the elderly," Avendano said. "We were surprised to see that it was not associated with stroke beyond age 65."
They speculate that it may be a case of "selective survival," where the poorer people die sooner than their richer neighbors, leaving those who reach old age among the wealthiest. Avendano and fellow researcher, M. Maria Glymour of the Harvard School of Public Health, say another explanation could be the later benefit that comes from full health coverage provided by Medicare after age 65. "It is possible, that because more people have care, the difference between the wealthy and others doesn't matter as much," Avendano said.

Stroke is the third leading cause of death in the United States. Approximately 780,000 people are affected by new or recurrent strokes each year, with 27 percent under the age of 65, according to the American Heart Association. If you are male, African-American, or have a family history of stroke, you are at a higher risk. While these factors can't be changed, there are things you can do to reduce your odds; eat a healthful diet, exercise, watch your weight, and abstain from tobacco.