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Socioeconomic disparities in stroke case fatality - Observations from Riks-Stroke, the Swedish stroke register

Lindmark, Anita; Glader, Eva-Lotta; Asplund, Kjell; Norrving, Bo LU and Eriksson, Marie (2014) In International Journal of Stroke 9(4). p.429-436
Abstract
Background Low socioeconomic status (low education and income level) has been found to be associated with increased stroke mortality. However, findings from previous studies on the association between socioeconomic status and case fatality (survival) after stroke have been inconsistent. Aims The study aims to explore the association between socio-economic status and survival after stroke using Riks-Stroke, the Swedish Stroke Register, with emphasis on changes in survival (in)equality with time after stroke. Methods All 76 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. Riks-Stroke data on 18- to 74-year-old patients with onset of first stroke during the years 2001-2009 were combined with data from other... (More)
Background Low socioeconomic status (low education and income level) has been found to be associated with increased stroke mortality. However, findings from previous studies on the association between socioeconomic status and case fatality (survival) after stroke have been inconsistent. Aims The study aims to explore the association between socio-economic status and survival after stroke using Riks-Stroke, the Swedish Stroke Register, with emphasis on changes in survival (in)equality with time after stroke. Methods All 76 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. Riks-Stroke data on 18- to 74-year-old patients with onset of first stroke during the years 2001-2009 were combined with data from other official Swedish registers. Case fatality was analyzed by socioeconomic status (education, income, country of birth, and cohabitation) and other patient characteristics. Results Of the 62 497 patients in the study, a total of 6094 (9 center dot 8%) died within the first year after stroke. Low income, primary school education, and living alone were independently associated with higher case fatality after the acute phase. Differences related to income and cohabitation were present already early, at 8-28 days after stroke, with the gaps expanding thereafter. The association between education and case fatality was not present until 29 days to one-year after stroke. Dissimilarities in secondary preventative medications prescribed on discharge from hospital had only a minor impact on these differences. Conclusions Socioeconomic status had only a limited effect on acute phase case fatality, indicating minor disparities in acute stroke treatment. The survival inequality, present already in the subacute phase, increased markedly over time since the stroke event. The socioeconomic differences could not be explained by differences in secondary prevention at discharge from hospital. Large socioeconomic differences in long-term survival after stroke may exist also in a country with limited income inequity. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
stroke, outcome, socioeconomic status, case fatality, registers
in
International Journal of Stroke
volume
9
issue
4
pages
429 - 436
publisher
Wiley-Blackwell
external identifiers
  • wos:000335664900013
  • scopus:84899987546
ISSN
1747-4949
DOI
10.1111/ijs.12133
language
English
LU publication?
yes
id
80dc4ad9-90a4-482c-a07b-e6f871eacb0a (old id 4558998)
date added to LUP
2014-08-01 07:41:42
date last changed
2017-08-13 03:19:18
@article{80dc4ad9-90a4-482c-a07b-e6f871eacb0a,
  abstract     = {Background Low socioeconomic status (low education and income level) has been found to be associated with increased stroke mortality. However, findings from previous studies on the association between socioeconomic status and case fatality (survival) after stroke have been inconsistent. Aims The study aims to explore the association between socio-economic status and survival after stroke using Riks-Stroke, the Swedish Stroke Register, with emphasis on changes in survival (in)equality with time after stroke. Methods All 76 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. Riks-Stroke data on 18- to 74-year-old patients with onset of first stroke during the years 2001-2009 were combined with data from other official Swedish registers. Case fatality was analyzed by socioeconomic status (education, income, country of birth, and cohabitation) and other patient characteristics. Results Of the 62 497 patients in the study, a total of 6094 (9 center dot 8%) died within the first year after stroke. Low income, primary school education, and living alone were independently associated with higher case fatality after the acute phase. Differences related to income and cohabitation were present already early, at 8-28 days after stroke, with the gaps expanding thereafter. The association between education and case fatality was not present until 29 days to one-year after stroke. Dissimilarities in secondary preventative medications prescribed on discharge from hospital had only a minor impact on these differences. Conclusions Socioeconomic status had only a limited effect on acute phase case fatality, indicating minor disparities in acute stroke treatment. The survival inequality, present already in the subacute phase, increased markedly over time since the stroke event. The socioeconomic differences could not be explained by differences in secondary prevention at discharge from hospital. Large socioeconomic differences in long-term survival after stroke may exist also in a country with limited income inequity.},
  author       = {Lindmark, Anita and Glader, Eva-Lotta and Asplund, Kjell and Norrving, Bo and Eriksson, Marie},
  issn         = {1747-4949},
  keyword      = {stroke,outcome,socioeconomic status,case fatality,registers},
  language     = {eng},
  number       = {4},
  pages        = {429--436},
  publisher    = {Wiley-Blackwell},
  series       = {International Journal of Stroke},
  title        = {Socioeconomic disparities in stroke case fatality - Observations from Riks-Stroke, the Swedish stroke register},
  url          = {http://dx.doi.org/10.1111/ijs.12133},
  volume       = {9},
  year         = {2014},
}