Socioeconomic Deprivation and Survival After Stroke

Chen, Ruoling; McKevitt, Christopher; Rudd, Anthony; Wolfe, Charles D.A.

doi:10.1161/strokeaha.113.003266

Cited by 37 publications

(19 citation statements)

References 24 publications

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“…[6][7][8] The possible mechanisms of SED increasing mortality could be through poorer quality of healthcare provision, apart from patient's higher risk-factor prevalence and severity of stroke. 11,30 The current study showed that patients with SED received poorer quality of some aspects of acute and secondary preventive care of stroke.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Status and the Quality of Acute Stroke Care

Pan

Chen

et al. 2016

Stroke

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Background and Purpose—The association of socioeconomic status (SES) with quality of stroke care is not well understood, and few studies have examined the association with different indicators of SES simultaneously. We assessed the impacts of low levels of education, occupation, and income on the quality of stroke care.\ud \ud Methods—We examined data from the China National Stroke Registry recording consecutive stroke patients between September 2007 and August 2008. Baseline low SES was measured using educational level <6 years, occupation as manual workers or no job, and average family income per capita at ≤¥1000 per month. Compliance with 11 performances was summarized in a composite score defined as the proportion of all needed care given. Poor quality of care was defined as having a composite score of 0.71 or less.\ud \ud Results—Among 12 270 patients with ischemic stroke, 38.6% had <6 educational years, 37.6% had manual workers/no job, and 34.7% had income ≤¥1000 per month. There was an increased chance of receiving poor quality of care in patients with low education (adjusted odds ratio 1.15, 95% confidence interval 1.03–1.28), low occupation (adjusted odds ratio 1.16, 95% confidence interval 1.01–1.32), and low income (adjusted odds ratio 1.18, 95% confidence interval 1.06–1.30), respectively. People with low SES had poor performances on some aspects of care quality. Combined effects existed among these SES indicators; those with low SES from all 3 indicators had the poorest quality of care.\ud \ud Conclusions—There was a social gradient in the quality of stroke care. Continuous efforts of socioeconomic improvement will increase the quality of acute stroke care

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Section: Discussionmentioning

confidence: 99%

Socioeconomic Status and the Quality of Acute Stroke Care

Pan

Chen

et al. 2016

Stroke

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“…In the UK, on the contrary, new data from the population-based South London Stroke Register (n=4398) found no significant difference in long-term survival (up to 17-year follow-up) associated with SES (see figure 4), except in the subgroup of black African and black Caribbean people, and differences associated with ethnic group were not significant once quality indicators of the of acute stroke care were adjusted for. 38 In summary, there is high-quality evidence that low SES is generally associated with increased risk of inhospital/short-term mortality but with some inconsistent evidence from contries with universal health care system such as Canda and UK showing no association. The relationship between SES and long-term survival is inconclusive and more high-quality studies on this are needed.…”

Section: Ses and Long-term Mortalitymentioning

confidence: 99%

The effects of socioeconomic status on stroke risk and outcomes

Marshall

Wang

Crichton

et al. 2015

The Lancet Neurology

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The latest international evidence on socio-economic status and stroke shows that stroke not only disproportionately affects low-and middle-income countries, but also socio-economically deprived populations within countries of all income categories. These disparities are found at every stage: from stroke prevention through acute care and rehabilitation, to long-term outcomes. Increased average levels of 'traditional' risk factors (hypertension, hyperlipidaemia, excess alcohol intake, smoking, obesity, sedentary lifestyle) in populations with lower SES appears to explain around half of the effect. In many countries there is evidence that people with lower SES are less likely to receive good quality acute hospital and rehabilitation care. For practice, better implementation of well-established treatments: traditional risk factor treatment and equity of access to high quality acute stroke care and rehabilitation seems likely to reduce inequality substantially. Overcoming barriers and adapting evidence-based interventions to different countries and healthcare settings remains a research priority.

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“…10 The SLSR methodology has been fully described before. 10,11 In brief, the SLSR is an ongoing prospective populationbased stroke register set up in January 1995, recording all first-ever strokes in patients of all ages living in 22 electoral wards in Lambeth and Southwark (total population at the 2011 census were 357 308) in South London. Stroke case ascertainment and data collection have been described in detail elsewhere.…”

Section: Data Collectionmentioning

confidence: 99%

“…Stroke case ascertainment and data collection have been described in detail elsewhere. 10,11 Data collected between January 1995 and December 2011 were used in this analysis. …”

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confidence: 99%

Association Between Socioeconomic Deprivation and Functional Impairment After Stroke

Chen

Crichton

McKevitt

et al. 2015

Stroke

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Stroke is a major public health problem as the population is ageing in the world. During the past 2 decades, the burden of stroke has increased from the fifth rank to the third, 1 and stroke remains the second cause of death.2 There is evidence that people with socioeconomic deprivation (SED) have an increased incidence of stroke and a higher mortality after stroke. 3,4 However, it is unclear whether SED is associated with functional impairment after stroke. Previous studies examining the association were of small sample size and had insufficient adjustment for potential confounders, showing conflicting findings. [5][6][7][8] There is a lack of data on the SED effect on long-term functional impairment after stroke. Although it is known that older or female patients are more likely to have SED and functional impairment after stroke in comparison with their counterparts, 8 it is unclear whether the effect of SED on functional recovery after stroke differs by age and sex. Recent data 9 showed that in patients with stroke, the prevalence of prestroke comorbidities, such as atrial fibrillation, has decreased during the past 2 decades. It is unknown whether the effect of SED on functional recovery after stroke is different among patients with and without these comorbidities. Although the number of patients with primary hemorrhagic stroke is increasing globally, no study has examined the association of SED with functional impairment after hemorrhagic stroke. In this study, we investigated the effect of SED on functional impairment after stroke in a long-term follow-up of population-based stroke register. We examined differences in the effect in terms of patients' age, sex, prestroke comorbidities, and stroke subtypes.Background and Purpose-Previous findings of the association between socioeconomic deprivation and functional impairment after stroke are inconsistent. There is a lack of data on long-term association. We assessed the association and differences by age, sex, prestroke comorbidities, and stroke phenotypes. Methods-We examined data from the South London Stroke Register cohort of 1995 to 2011, recording all first-ever strokes in patients of all ages in South London. A total of 2104 patients were alive at 3 months after stroke. Socioeconomic deprivation was measured using the index of multiple deprivation based on patient postcodes, and functional impairment after stroke was defined as a Barthel index of <15. Results-At 3 months after stroke, 643 patients had functional impairment (30.6%; 95% confidence interval, 28.6%-32.5%).Compared with the first quartile of index of multiple deprivation (the least deprived), multivariate-adjusted odds ratios for functional impairment in patients with the second, third, and fourth quartiles were 1. Methods Data CollectionThe study population was derived from the South London Stroke Register (SLSR). 10 The SLSR methodology has been fully described before. 10,11 In brief, the SLSR is an ongoing prospective populationbased stroke register set up in January 1995, recording all ...

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Socioeconomic Deprivation and Survival After Stroke

Cited by 37 publications

References 24 publications

Socioeconomic Status and the Quality of Acute Stroke Care

Socioeconomic Status and the Quality of Acute Stroke Care

The effects of socioeconomic status on stroke risk and outcomes

Association Between Socioeconomic Deprivation and Functional Impairment After Stroke

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