• Association Between Socioeconomic Deprivation and Functional Impairment After Stroke: the South London Stroke Register

      Chen, Ruoling; Crichton, Siobhan; McKevitt, Christopher; Rudd, Anthony G.; Sheldenkar, Anita; Wolfe, Charles D.A. (AHA, 2015-02-03)
      OBJECTIVES: To determine the impacts of socioeconomic deprivation (SED) on short and long term functional impairment after stroke and differences by age, sex, pre-stroke co-morbidities and stroke phenotypes. DESIGN: Population based stroke register. SETTING: South London. PARTICIPANTS: 2,104 patients recruited the South London Stroke Register between 1995 and 2011 and were alive at 3 months after first ever stroke. MAIN OUTCOME MEASURES: Functional impairment defined as Barthel Index (BI) of <15 at 3 months and at 3 years after stroke. RESULTS: At 3 months after stroke 643 patients had functional impairment (30.6%, 95%CI 28.6%-32.5%). Compared with the 1st quartile of Index of Multiple Deprivation score (IMD) (the least deprived), multivariate adjusted odds ratios (OR) for functional impairment in patients with the 2nd, 3rd and 4th quartiles were 1.29 (95%CI 0.94-1.76), 1.33 (0.97-1.82) and 1.78 (1.31-2.43). The impact was significant in patients aged >=65 years (ORs in the 2nd, 3rd and 4th quartiles were 1.49 (1.02-2.17), 1.21 (0.83-1.75) and 1.94 (1.34-2.81), overall p=0.003) but not in younger patients (p=0.119), in women (p=0.008) but not in men (p=0.466), in patients who do not have pre-stroke co-morbidities (p=0.009) but not in patients with these (p=0.140)), and in ischemic stroke (p<0.001) but not in haemorrhagic stroke (p=0.141). At 3 years after stroke, 289 of survivors who had BI measured had functional impairment (26.1%, 95%CI 23.5%-28.7%). Compared with the 1stquartile of IMD, multivariate adjusted OR for functional impairment in the 2nd, 3rd and 4th quartiles were 1.09 (0.70-1.69), 1.34 (0.87-2.07) and 1.77 (1.15-2.72). The differences in the association by age, sex, pre-stroke co-morbidities and types of stroke were similar to those at 3 months after stroke. CONCLUSIONS There are significant inequalities in both short and long term functional recovery after stroke. General socioeconomic improvement, targeting high risk groups of functional impairment are likely to reduce inequality in functional recovery after stroke.