The effect of socioeconomic status on three-year mortality after first-ever ischemic stroke in Nanjing, China

Abstract

BackgroundLow socioeconomic status (SES) is associated with increased mortality after stroke in developed countries. This study was performed to determine whether a similar association also exists in China.MethodsA total of 806 patients with first-ever ischemic stroke were enrolled in our study. From August 1999 to August 2005, the three-year all-cause mortality following the stroke was determined. Level of education, occupation, taxable income and housing space were used as indicators for SES. Stepwise univariate and multivariate COX proportional hazards models were used to study the association between the SES measures and the three-year mortality.ResultsOur analyses confirmed that occupation, taxable income and housing space were significantly associated with three-year mortality after first-ever stroke. Manual workers had a significant hazard ratio of 5.44 (95% CI 2.75 to 10.77) for death within three years when compared with non-manual workers. Those in the zero income group had a significant hazard ratio of 5.35 (95% CI 2.95 to 9.70) and those in the intermediate income group 2.10 (95% CI 1.24 to 3.58) when compared with those in the highest income group. Those in two of the three groups with the smallest housing space also had significant hazard ratios of 2.06 (95% CI 1.16 to 3.65) and 1.68 (95% CI 1.12 to 2.52) when compared with those in group with the largest housing space. These hazard ratios remained largely unchanged after multivariate adjustment for age, gender, baseline cardiovascular disease risk factors, and stroke severity. The analyses did not confirm an association with educational level.ConclusionLower SES has a negative impact on the outcome of first-ever stroke in Nanjing, China. This confirms the need to improve preventive and secondary care for stroke among low SES groups.

Socioeconomic Differences in Quality of Care and Clinical Outcome After Stroke

“…7 Several studies have reported an association between SES and mortality after stroke based on different SES indicators but without controlling for differences in care. 6,9,10,12 In contrast, other studies reported no association between SES and stroke mortality when using SES indicators based on occupation or area-based deprivation indices. 3,5,13,14 We found no association between educational level and mortality, which confirms previous observations.…”

“…3,5,13,14 We found no association between educational level and mortality, which confirms previous observations. 4,9,10 A few studies have reported sex specific socioeconomicrelated differences in mortality. Jakovljevic et al found an association between low education and 28-day and 1-year case-fatality, which was limited to women aged 25 to 59 years.…”

Educational History Is an Independent Predictor of Cognitive Deficits and Long-Term Survival in Postacute Patients With Mild to Moderate Ischemic Stroke

“…[21][22][23] The reason why education itself was not associated with mortality in previous studies may be explained by shorter follow-up periods limited to 3 years 21,22 and considerably smaller numbers of patients. 22,34 We consider the effect of educational history to be effective in long-term follow-up modulating patient cooperation and compliance. The effect of different health care systems and overall socioeconomic status may prevent direct comparison of the results with previous ones.…”

“…The effect of different health care systems and overall socioeconomic status may prevent direct comparison of the results with previous ones. 34 Patients living alone were more often poorly educated. Because social support also is an important factor modifying stroke mortality, 13 we adjusted our analyses with marital status, therefore excluding the potential confounding effect.…”

Determinan Penyakit Stroke

“…Penelitian di China, pasien mengalami stroke pada usia < 50 tahun karena proporsi merokok dan konsumsi minuman beralkohol yang tinggi. 10 Kenaikan risiko serebro infark dan faktor risiko vaskuler pada umur dewasa muda terutama terjadi di negara berkembang berhubungan dengan peningkatan perilaku merokok dan urbanisasi. 11 Berdasarkan status ekonomi, responden yang miskin (kuintil 1 dan kuintil 2) berisiko lebih tinggi untuk mengalami stroke dibandingkan dengan status ekonomi yang lebih tinggi (tidak miskin).…”