Socioeconomic deprivation and provision of acute and long-term care after stroke: the South London Stroke Register cohort study.
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.
['Chen|Ruoling|R|', 'McKevitt|Christopher|C|', 'Crichton|Siobhan L|SL|', 'Rudd|Anthony G|AG|', 'Wolfe|Charles D A|CD|']
D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D005260:Female D006801:Humans D016015:Logistic Models D008131:London D008134:Long-Term Care D008297:Male D008875:Middle Aged D011203:Poverty D011787:Quality of Health Care D044469:Racial Groups D012042:Registries D012959:Socioeconomic Factors D020521:Stroke
STROKE EPIDEMIOLOGY