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dc.contributor.authorChen, Ruoling; McKevitt, Christopher; Crichton, Siobhan L.; Rudd, Anthony G.; Wolfe, Charles D A.
dc.contributor.authorCrichton, Siobhan L
dc.contributor.authorMcKevitt, Christopher
dc.contributor.authorRudd, Anthony G
dc.contributor.authorWolfe, Charles D A
dc.date.accessioned2017-11-22T11:23:25Z
dc.date.available2017-11-22T11:23:25Z
dc.date.issued2014-04-13
dc.identifier.issn0022-3050
dc.identifier.issn1468-330X
dc.identifier.doi10.1136/jnnp-2013-306413
dc.identifier.urihttp://hdl.handle.net/2436/620884
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.
dc.description.sponsorshipNational Institute for Health Research Programme Grant (RP-PG-0407-10184)
dc.language.isoen
dc.publisherBMJ
dc.subjectSocioeconomic deprivation
dc.subjectprovision of acute and long-term care
dc.subjectstroke
dc.titleSocioeconomic deprivation and provision of acute and long-term care after stroke: the South London Stroke Register cohort study
dc.typeJournal article
dc.identifier.journalJournal of Neurology, Neurosurgery & Psychiatry
dc.date.accepted2014-02-26
dc.source.volume85
dc.source.issue12
dc.source.beginpage1294
dc.source.endpage1300
refterms.dateFOA2018-08-21T14:35:18Z
html.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.


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