Neighbourhood health inequity and the incidence of stroke and transient ischemic attack

INTRODUCTION: Despite generous welfare systems and equitable built environments previous research has shown clear differences in cardiovascular health between areas with different socioeconomic status (SES) in Sweden. To direct public health initiatives, there is a need for updated data of SES differences in stroke and whether transient ischemic attack (TIA) incidence also differs based on neighbourhood SES. PATIENTS AND METHODS: Within the Multimorbidity Integrated Registry Across Care Levels in Stockholm cohort (MIRACLE-S), encompassing healthcare visits and diagnoses from all care levels, we followed 1.4 million individuals without a history of stroke or TIA for 12 years (2014-2025). We used Cox and Poisson regression and analysed both the baseline risk prospectively and a time updated analysis in different neighbourhood-SES. RESULTS: Neighbourhoods with low SES had a higher incidence of stroke. Among both men and women, SES difference in stroke incidence were greatest before age 65, with no significant differences at age 80 or older. For TIA, we observed a higher incidence in high SES neighbourhoods, particularly among men. DISCUSSION: The higher stroke incidence in low SES neighbourhoods indicates a need for targeted prevention. Low awareness and underdiagnosis may explanation the lower risk of TIA in low SES neighbourhoods, supporting targeted efforts to improve TIA detection, which could in turn help prevent stroke. Effective mitigation likely requires geographically focused medical care and primary prevention in low-SES neighbourhoods.