Literacy as a Social Determinant of Stroke
By Uzoma Adebayo
Stroke is a leading cause of disability and mortality worldwide (WHO, 2022) with 50% of all disabilities attributable to stroke (Donkor E. S. 2018). This is an alarming rate for a disease with a 90% occurrence attributable to modifiable risk factors (Hill. V.A & Towfighi. A, 2017). Many studies have explored the causal association between stroke and modifiable risk factors, but there is a dearth of data identifying literacy levels as a determinant of stroke. Literacy is measured by the attainment of formal education and people who are literate have a higher socioeconomic status and health literacy, which goes a long way to determine their health outcomes. The ability for a person to make healthy decisions such as increasing physical activity levels, avoidance of tobacco products, maintaining a healthy diet and seeking expert medical attention, all of which are physiological risk factors for stroke, is affected by their level of education. This means that literacy plays a key role in the intervention for stroke.
In a prospective cohort study done by Yusuf et al (2020) to assess the modifiable risk factors and its impact on cardiovascular disease and mortality, they found out that low education level was the highest single risk factor for cardiovascular diseases such as stroke. This study was done among 155,722 individuals from 21 high income, middle income, and low-income countries, between 2005 and 2016, with 89% of the participants from low- and middle-income countries. Results from the study also showed that household air pollution, poor diet and low grip strength were risk factors for cardiovascular diseases in low- and middle-income countries, but low education level was a risk factor for all country income levels.
Another study by Xiuyun, Qian and Minjun et al (2020) which aimed to characterize the association between education and incident stroke, found that higher education was associated with a decreased rate of total and ischemic stroke. The study revealed a 33% and 17% decreased stroke incidence for individuals with advanced and intermediate education respectively, after adjusting for traditional modifiable risk factors. This was consistent even after adjusting for family income.
Jackson, Sudlow and Mishra in their 2018 prospective cohort study which aimed to determine if the association between education and stroke differed by sex and age, found out that there was an inverse relationship between education and stroke incidence after adjusting for age. This shows that across all ages, quality education is still important in the prevention of stroke.
There is evidence to show that higher education levels are associated with a decreased stroke incidence. This is no surprise as higher education levels are directly related to socioeconomic status, which has been established to be a determinant of health (Donkor E. S. 2018) as people with higher education are able to get higher paying jobs which gives them access to better health services. Public health measures should include policies that improve access to quality education, as this goes a long way to reduce the incidence of stroke and the burden of the disease globally.
