Socioeconomic deprivation and provision of acute and long-term care after stroke: the South London Stroke Register cohort study

2.50
Hdl Handle:
http://hdl.handle.net/2436/620884
Title:
Socioeconomic deprivation and provision of acute and long-term care after stroke: the South London Stroke Register cohort study
Authors:
Chen, Ruoling; McKevitt, Christopher; Crichton, Siobhan L.; Rudd, Anthony G.; Wolfe, Charles D A.
Abstract:
Background and aims Socioeconomic deprivation (SED) is associated with increased mortality after stroke, however, its associations with stroke care remains uncertain. We assessed the SED impacts on acute and long-term stroke care, and examined their ethnic differences and secular trends. Methods We used data from 4202 patients with first-ever stroke (mean age 70.1 years, 50.4% male, 20.4% black), collected by a population-based stroke register in South London, England from 1995 to 2010. Carstairs deprivation score was measured for each patient, taking the 1st as the least deprived and the 2nd to 5th quintiles as SED, and was related to 20 indicators of care in multivariate logistic regression models. Results Patients with SED had 29% and 35% statistically significant reductions in odds of being admitted to hospital and having swallow tests, respectively. The multivariate adjusted odds ratio (OR) for receiving five indicators of acute stroke care was 0.81 (95% CI 0.72 to 0.92). It was 0.76 (0.58 to 0.99) in black patients and 0.82 (0.71 to 0.96) in white patients; and 0.70 (0.58 to 0.84) in patients with stroke occurring before 2001 and 0.89 (0.75 to 1.05) since 2001. SED was further associated with receipt of some stroke care during 5 years of follow-up, including atrial fibrillation medication (0.63, 0.48 to 0.83), and in black patients physiotherapy and occupational therapy (0.32, 0.11 to 0.92). Conclusions Stroke healthcare inequalities in England exist for some important indicators, although overall it has improved over time. The impact of SED may be stronger in black patients than in white patients. Further efforts are required to achieve stroke care equality.
Publisher:
BMJ
Journal:
Journal of Neurology, Neurosurgery & Psychiatry
Issue Date:
Dec-2014
Type:
Article
Language:
en
ISSN:
0022-3050; 1468-330X
Sponsors:
National Institute for Health Research Programme Grant (RP-PG-0407-10184)
Appears in Collections:
FEHW

Full metadata record

DC FieldValue Language
dc.contributor.authorChen, Ruoling; McKevitt, Christopher; Crichton, Siobhan L.; Rudd, Anthony G.; Wolfe, Charles D A.en
dc.date.accessioned2017-11-22T11:23:25Z-
dc.date.available2017-11-22T11:23:25Z-
dc.date.issued2014-12-
dc.identifier.issn0022-3050-
dc.identifier.issn1468-330X-
dc.description.abstractBackground and aims Socioeconomic deprivation (SED) is associated with increased mortality after stroke, however, its associations with stroke care remains uncertain. We assessed the SED impacts on acute and long-term stroke care, and examined their ethnic differences and secular trends. Methods We used data from 4202 patients with first-ever stroke (mean age 70.1 years, 50.4% male, 20.4% black), collected by a population-based stroke register in South London, England from 1995 to 2010. Carstairs deprivation score was measured for each patient, taking the 1st as the least deprived and the 2nd to 5th quintiles as SED, and was related to 20 indicators of care in multivariate logistic regression models. Results Patients with SED had 29% and 35% statistically significant reductions in odds of being admitted to hospital and having swallow tests, respectively. The multivariate adjusted odds ratio (OR) for receiving five indicators of acute stroke care was 0.81 (95% CI 0.72 to 0.92). It was 0.76 (0.58 to 0.99) in black patients and 0.82 (0.71 to 0.96) in white patients; and 0.70 (0.58 to 0.84) in patients with stroke occurring before 2001 and 0.89 (0.75 to 1.05) since 2001. SED was further associated with receipt of some stroke care during 5 years of follow-up, including atrial fibrillation medication (0.63, 0.48 to 0.83), and in black patients physiotherapy and occupational therapy (0.32, 0.11 to 0.92). Conclusions Stroke healthcare inequalities in England exist for some important indicators, although overall it has improved over time. The impact of SED may be stronger in black patients than in white patients. Further efforts are required to achieve stroke care equality.en
dc.description.sponsorshipNational Institute for Health Research Programme Grant (RP-PG-0407-10184)en
dc.language.isoenen
dc.publisherBMJen
dc.subjectSocioeconomic deprivationen
dc.subjectprovision of acute and long-term careen
dc.subjectstrokeen
dc.titleSocioeconomic deprivation and provision of acute and long-term care after stroke: the South London Stroke Register cohort studyen
dc.typeArticleen
dc.identifier.journalJournal of Neurology, Neurosurgery & Psychiatryen
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