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dc.contributor.authorChen, Ruoling; Hu, Zhi; Chen, Ruo-Li; Zhang, Dongmei; Xu, Long; Wang, Jingjing; Wei, Li.
dc.contributor.authorHu, Zhi
dc.contributor.authorChen, Ruo-Li
dc.contributor.authorZhang, Dongmei
dc.contributor.authorXu, Long
dc.contributor.authorWang, Jingjing
dc.contributor.authorWei, Li
dc.date.accessioned2017-11-22T10:13:03Z
dc.date.available2017-11-22T10:13:03Z
dc.date.issued2015-01-30
dc.identifier.issn2044-6055
dc.identifier.doi10.1136/bmjopen-2014-005688
dc.description.abstractObjective: To assess the association of socioeconomic deprivation (SED) with survival after stroke in China. Design: A systematic literature review and a new population-based cohort study. Setting and participants: In urban and rural communities in Anhui, China, 2978 residents aged ≥60 years took part in baseline investigation and were followed up for 5 years; five published studies were identified for a systematic review. Primary and secondary outcome measures: 167 of 2978 participants (5.6%) had doctor-diagnosed stroke at baseline or 1 year later. All-cause mortality in the follow-up. Results: In the Anhui cohort follow-up of 167 patients with stroke, 64 (38.3%) died. Multivariate adjusted hazard ratio (HR) of mortality in patients with educational level of less than or equal to primary school was 1.88 (95% CI 1.05 to 3.36) compared to those having more than primary school education. Increased HR of mortality in patients living in a rural area was at borderline significant (1.64, 0.97 to 2.78), but the HR in patients with lower levels of occupation and income was not significant. Published studies showed a significant increase in stroke mortality in relation to some SED indicators. Pooled relative risk (RR) of mortality in patients with low education was 3.07 (1.27 to 7.34), in patients with low income 1.58 (1.50 to 1.65) and in patients living in rural areas 1.47 (1.37 to 1.58). Conclusions: The evidence suggests the presence of a mortality gradient after stroke for material as well as social forms of deprivation in China. Inequalities in survival after stroke persist and need to be taken into account when implementing intervention programmes.
dc.description.sponsorshipThe Royal Society, UK (Grant No.574006.G603/22085), the BUPA Foundation, UK (Grants Nos. 45NOV06 and TBF-M09–05), Anhui Province Natural Science Fund, China.
dc.language.isoen
dc.publisherBMJ
dc.subjectSocioeconomic deprivation
dc.subjectsurvival after stroke
dc.subjectChina
dc.titleSocioeconomic deprivation and survival after stroke in China: a systematic literature review and a new population-based cohort study.
dc.typeJournal article
dc.identifier.journalBMJ Open
dc.identifier.urlhttp://dx.doi.org/10.1136/bmjopen-2014-005688
rioxxterms.funderUniversity of Wolverhampton
rioxxterms.identifier.projectUOW121117RC
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by-nc/4.0/
rioxxterms.licenseref.startdate2017-11-22
dc.source.volume5
dc.source.issue1
dc.source.beginpage1
dc.source.endpage10
refterms.versionFCDVoR
refterms.dateFOA2018-08-21T14:31:58Z
html.description.abstractObjective: To assess the association of socioeconomic deprivation (SED) with survival after stroke in China. Design: A systematic literature review and a new population-based cohort study. Setting and participants: In urban and rural communities in Anhui, China, 2978 residents aged ≥60 years took part in baseline investigation and were followed up for 5 years; five published studies were identified for a systematic review. Primary and secondary outcome measures: 167 of 2978 participants (5.6%) had doctor-diagnosed stroke at baseline or 1 year later. All-cause mortality in the follow-up. Results: In the Anhui cohort follow-up of 167 patients with stroke, 64 (38.3%) died. Multivariate adjusted hazard ratio (HR) of mortality in patients with educational level of less than or equal to primary school was 1.88 (95% CI 1.05 to 3.36) compared to those having more than primary school education. Increased HR of mortality in patients living in a rural area was at borderline significant (1.64, 0.97 to 2.78), but the HR in patients with lower levels of occupation and income was not significant. Published studies showed a significant increase in stroke mortality in relation to some SED indicators. Pooled relative risk (RR) of mortality in patients with low education was 3.07 (1.27 to 7.34), in patients with low income 1.58 (1.50 to 1.65) and in patients living in rural areas 1.47 (1.37 to 1.58). Conclusions: The evidence suggests the presence of a mortality gradient after stroke for material as well as social forms of deprivation in China. Inequalities in survival after stroke persist and need to be taken into account when implementing intervention programmes.


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