Impact of socioeconomic deprivation on mortality in people with haemorrhagic stroke: a population-based cohort study

Abstract

Purpose: Socioeconomic deprivation (SED) has an effect on many health outcomes, including ischaemic stroke, however its impact on mortality after haemorrhagic stroke remains unclear, particularly in the long run. We examined this association in a multi-ethnic population in the UK. Design: We examined data from 782 patients with first-ever haemorrhagic stroke, collected by the South London Stroke Register from 1995 to 2011. SED was defined as the quartile with the highest Carstairs scores, and was analysed in relation to mortality after stroke in a multivariate-adjusted Cox regression model. Results: In a follow-up of 17 years, 498 patients died. Compared with the 1st quartile of Carstairs score (the least deprived), the multivariate-adjusted hazard ratios (HRs) for 17-year mortality in patients in the 2nd, 3rd and 4th quartiles were 0.94 (95%CI 0.72-1.23), 1.17 (0.90-1.52) and 1.36 (1.04-1.78), overall p=0.04. The SED gradient association remained in patients with intracerebral haemorrhagic stroke, while in patients with subarachnoid haemorrhagic stroke the corresponding HRs were 2.62 (1.22-5.64), 3.03 (1.49-6.18) and 1.83 (0.87-3.83) respectively. Results of 10-year mortality showed similar patterns, although the association of deprivation with 1-year mortality was not significant. Conclusions: There is a significant impact of SED on long-term mortality after haemorrhagic stroke. The reasons for this survival inequality must be explored to reduce mortality in patients with haemorrhagic stroke.