Socioeconomic Deprivation and Survival After Stroke

Ruoling Chen · Christopher McKevitt · Anthony George Rudd · Charles D.A. Wolfe

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Health disparities and outcomes Acute Ischemic Stroke Management Public Health and Social Inequalities

Abstract

BACKGROUND AND PURPOSE: Previous findings of the association between socioeconomic deprivation (SED) and survival after stroke are inconsistent. There is less investigation on long-term survival. We assessed the associations in a multi-ethnic population in England. METHODS: We examined data from 4398 patients (3103 whites, 932 blacks, and 253 Asians/others) with first-ever stroke, collected by a population-based stroke register in South London from 1995 to 2011. SED was measured using the Carstairs index score-the higher score, the more deprived. It was analyzed in multivariate Cox regression models in relation to survival after stroke. RESULTS: During 17-year follow-up 2754 patients died. The quartile data of Carstairs score showed no significant association of SED with survival in patients, except for black Caribbeans and Africans. Black patients with the fourth quartile SED had a multivariate adjusted hazard ratio of 1.76 (95% confidence interval, 1.06-2.94) for 3-month mortality and 1.54 (1.00-2.37) for 1-year mortality. After adjustment for acute stroke care provisions, these were no longer significant. However, the sextile data of Carstairs score showed a consistent association of SED with survival after stroke; all patients with the sixth sextile had a fully adjusted hazard ratio of 1.23 (1.05-1.44) for 3-month mortality and 1.13 (1.01-1.25) for 17-year mortality. CONCLUSIONS: There is a weak but significant association of SED with reduced survival after stroke in England. SED in blacks may have a stronger impact on short-term survival when compared with white patients. Further efforts are required to achieve equality in survival among patients with stroke of different socioeconomic groups.

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References

1993Deprivation and Health in Scotland 1992Deprivation and Health in Scotland 1989Deprivation: explaining differences in mortality between Scotland and England and Wales.2006Socioeconomic status and stroke 2013Neighborhood socioeconomic disadvantage and mortality after stroke 2000Social Patterning of Myocardial Infarction and Stroke in Sweden: Incidence and Survival

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