ArticleBMC public health2020
Socioeconomic status and survival after stroke - using mediation and sensitivity analyses to assess the effect of stroke severity and unmeasured confounding.
Article in BMC public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- A systematic review of causal pathways of socioeconomic inequalities in stroke.International journal of stroke : official journal of the International Stroke Society · 2026Pooled it
- Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis.Sensors (Basel, Switzerland) · 2021Pooled it
- Social determinants of health and stroke care and outcomes: SEQUINS lecture 2025.Equity neuroscience · 2026Article
- Temporal Trends and Drivers of Socioeconomic Inequalities in Stroke Care, Survival, and Long-Term Outcomes.Journal of the American Heart Association · 2026Article
- Upper Extremity Motor Evoked Potentials and Hand Function in Elderly Stroke Survivors: A Correlational Study.Journal of clinical medicine · 2026Article
- Systemic Inflammation Mediates the Association Between Atrial Fibrillation and Functional Outcomes After Ischemic Stroke.Journal of inflammation research · 2026Article
- Article
- Investigating Multiple Mediators to Mitigate Socioeconomic Differences in Patient-Reported Outcomes After Stroke: A Nationwide Register-Based Study.Journal of the American Heart Association · 2025Article
- Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers.Stroke · 2025Review
- Mediation Analyses of the Mechanisms by Which Socioeconomic Status, Comorbidity, Stroke Severity, and Acute Care Influence Stroke Outcome.Neurology · 2023Article
- Observational
- Is the socioeconomic inequality in stroke prognosis changing over time and does quality of care play a role?European stroke journal · 2023Article
- Stroke severity mediates the effect of socioeconomic disadvantage on poor outcomes among patients with intracerebral hemorrhage.Frontiers in neurology · 2023Article
- Association of Socioeconomic Status and Infarct Volume With Functional Outcome in Patients With Ischemic Stroke.JAMA network open · 2022Article
- Article
- Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAlthough it has been established that low socioeconomic status is linked to increased risk of death after stroke, the mechanisms behind this link are still unclear. In this study we aim to shed light on the relationship between income level and survival after stroke by investigating the extent to which differences in stroke severity account for differences in survival.
methodsThe study was based on patients registered in Riksstroke (the Swedish stroke register) with first time ischemic stroke (n = 51,159) or intracerebral hemorrhage (n = 6777) in 2009-2012. We used causal mediation analysis to decompose the effect of low income on 3-month case fatality into a direct effect and an indirect effect due to stroke severity. Since causal mediation analysis relies on strong assumptions regarding residual confounding of the relationships involved, recently developed methods for sensitivity analysis were used to assess the robustness of the results to unobserved confounding.
resultsAfter adjustment for observed confounders, patients in the lowest income tertile had a 3.2% (95% CI: 0.9-5.4%) increased absolute risk of 3-month case fatality after intracerebral hemorrhage compared to patients in the two highest tertiles. The corresponding increase for case fatality after ischemic stroke was 1% (0.4-1.5%). The indirect effect of low income, mediated by stroke severity, was 1.8% (0.7-2.9%) for intracerebral hemorrhage and 0.4% (0.2-0.6%) for ischemic stroke. Unobserved confounders affecting the risk of low income, more severe stroke and case fatality in the same directions could explain the indirect effect, but additional adjustment to observed confounders did not alter the conclusions.
conclusionsThis study provides evidence that as much as half of income-related inequalities in stroke case fatality is mediated through differences in stroke severity. Targeting stroke severity could therefore lead to a substantial reduction in inequalities and should be prioritized. Sensitivity analysis suggests that additional adjustment for a confounder of greater impact than age would be required to considerably alter our conclusions.
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Registered trials
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