More Risk Factors, Less Access to Care Behind Higher Stroke Rates in U.S.
-- A higher rate of risk factors and more barriers to health care may be among the reasons why stroke is more common in the United States than in Europe, a new study suggests.
Researchers examined 2004 data on 13,667 people in the United States and 30,120 people in 11 European countries, and found that American men were 61 percent more likely to suffer a stroke than European men, and American women were almost twice as likely as European women to have a stroke.
"Most of this gap [in stroke risk] is among relatively poor Americans who were, in our data, much more likely to have a stroke than poor Europeans, whereas the gap in stroke prevalence is less marked between rich Americans and rich Europeans," study author Mauricio Avendano, a research fellow in public health at the Erasmus Medical Center in Rotterdam, the Netherlands, said in a prepared statement.
The data analysis included stroke occurrence, socioeconomic status, and major risk factors for stroke, including obesity, diabetes, smoking, physical activity and alcohol consumption.
Overall, women were about 25 percent less likely than men to have a stroke, the study found.
"Many risk factors for stroke, including blood pressure and smoking, have generally increased among women but remained stable among men," Avendano said. "This may explain why the gap in stroke prevalence between men and women is less marked than before. In fact, in some age groups and populations such as France, women may have higher prevalence of stroke than men."
The researchers found that age-adjusted stroke prevalence varied considerably between countries. It was highest in the United States and lowest in the southern Mediterranean countries of Spain, Italy and Greece, as well as in Switzerland.
"Southern Mediterranean countries have a diet rich in vegetables, fruits and fish, and lower in fats, which partly explains why heart disease is so much lower in these populations than in northern Europe and the United States," Avendano said.
The team also found that higher stroke prevalence was associated with lower socioeconomic status as measured by wealth, income and education. This link was stronger in the United States than in most European countries.
"Beyond the contribution of specific risk factors, policies that differ dramatically between Europe and the United States may play a role," Avendano said.
Europe offers universal health care and some European health systems emphasize "tackling stroke risk factors, as opposed to the U.S. health-care system, which focuses more on treatment and may actually be more successful in keeping stroke cases alive."
In addition, differences in transportation and nutrition policies may make Americans less likely than Europeans to exercise or eat a healthy diet.
"Risk factors alone do not account for the differences we found, which points to the role of broader health care and structural policies," Avendano said.
The study was presented Friday at the American Stroke Association's International Stroke Conference, in New Orleans.
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