Wealth Lowers Stroke Risk, No Surprise

Besides having healthier habits, the wealthy are more apt to seek care.


Money can't buy you love or happiness, but it may protect you from having a stroke. That's the takeaway from a new study in the journal Stroke, released today. Researchers found that the least wealthy were three times more likely to have a stroke between ages 50 and 64 compared with those who were in the top 75th to 89th percentile in wealth (the very wealthiest outliers were excluded). Once people hit 65, however, all bets were off, and wealth no longer afforded them protection.

The study examined the effect of education, income (annual earnings), and wealth (all housing and financial assets) on nearly 20,000 participants in the ongoing University of Michigan Health and Retirement Study. It's the first study to find that wealth predicts stroke incidence independently of income and education, according to Mauricio Avendano, a research fellow in public health at the Erasmus Medical Center in Rotterdam and coauthor of the study, in a press release announcing the findings.

Stroke is the third leading cause of death in the United States, striking some 780,000 people annually. The idea that people who are better off are less likely to have a stroke—however you define "better off"—doesn't set off any surprise bells. We know that people lower on the socioeconomic scale tend to smoke, be overweight, consume alcohol, and suffer from diabetes in greater numbers than those with more resources. These are all risk factors for stroke. Along similar lines, the study found that subjects ages 50 to 74 who had less income, wealth, or education had higher rates of high blood pressure, smoking, low physical activity, heart disease, diabetes and being overweight—stroke risk factors all.

But even when study authors adjusted for these risks, basically removing them from the equation, wealth and income continued to influence the likelihood of stroke (education turned out not to be predictive once wealth and income were factored in). This is where access to good-quality, reliable healthcare probably comes into play, say experts, as well as other less tangible advantages.

People who fall into that gray area—not poor enough to qualify for Medicaid, not well off enough to afford good private insurance—don't get the timely preventive and other regular care that 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." With a stroke, that can be risky business, since prompt treatment is key to mitigating the damage. (I recently reported about how lack of insurance results in later cancer diagnoses.)

The study authors speculate about other ways in which financial security may affect people's risk, noting that "wealth may increase individuals' sense of control over their lives, reducing psychosocial stress and subsequently stroke risk." Other psychosocial risk factors like depression and lack of social support that are more common among lower socioeconomic groups may play a role as well, they note.

Only about 27 percent of strokes occur in people under age 65, according to the American Heart Association. So it's interesting that in this study, the association between wealth and stroke risk mostly disappeared among those over 65. Researchers can't explain the result, but they speculate that it may be thanks to "selective survival": Poorer people die sooner than their richer neighbors, leaving those who make it into old age among the healthiest. (Check out a recent report on the health of older Americans.)

There are some stroke risk factors you can't change. If you're male, have a family history of stroke or are African-American you're unfortunately at higher risk. But there are things you can do to reduce your odds, as noted above: Exercise, eat a healthful diet, don't smoke. And while you're at it, play the lottery. You may have a stroke of luck.