Are there socio-economic inequities in access to reperfusion therapy: The stroke 69 cohort

Perrin, Agnès; Freyssenge, Julie; Haesebaert, Julie; Tazarourte, Karim; Termoz, Anne; Grimaud, Olivier; Derex, Laurent; Viprey, Marie; Schott, Anne‐Marie

doi:10.1016/j.neurol.2021.02.394

Cited by 4 publications

(8 citation statements)

References 31 publications

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“…Indeed, there is an association between the number of b eds in stroke units and the likelihood of admission to such units, showing difficulties of access to a stroke unit for all patients with stroke. One study has found no significant association between socioeconomic deprivation and access to reperfusion therapy [40], but it was conducted in only one French county and used an ecological approach, which suggests that further studies are needed. A survey of access to acute stroke unit care, thrombolysis and endo‐vascular treatment in 44 European countries found major inequalities in acute stroke treatment between and within countries [41].…”

Section: Discussionmentioning

confidence: 99%

Social inequalities and gender differences in healthcare management of acute ischaemic stroke in France

Naouri

Allain

Fery-Lemonier

et al. 2022

Euro J of Neurology

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Background and purpose: There are regional disparities in access to stroke units in France.Several studies have shown that living in disadvantaged areas is associated with a higher frequency of stroke, worse severity at presentation, increased level of dependency and higher mortality rates. However, few studies have explored the association between an individual's socioeconomic characteristics and stroke care. Our study aimed to determine if living standards are associated with stroke unit access for patients admitted to hospital for acute ischaemic stroke.Methods: Using the EDP-Santé French administrative database, all patients admitted to hospital for acute ischaemic stroke between 2014 and 2017 were selected. Acute ischaemic stroke corresponded to hospital stay with International Classification of Diseases 10th Revision codes I63 or I64 as the main diagnosis. Multivariate logistic regression was used to identify if standard of living was associated with likelihood of admission to a stroke unit.Results: In all, 14,123 acute care episodes were identified, corresponding to 335,273 episodes in the general population when appropriately weighted. Of these, 52.9% were admitted to a stroke unit. Being in the first (i.e., poorest) living standard quartile was associated with lower likelihood of admission to a stroke unit compared with the fourth (i.e., wealthiest) quartile, and was associated with a higher likelihood of paralysis and language disorder, and death at 1 year. Conclusion:A low living standard was associated with lower likelihood of admission to a stroke unit as well as a greater chance of paralysis and aphasia at the end of hospitalization and a higher possibility of death at 1 year after stroke. Greater access to stroke units for disadvantaged people should be promoted.

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Section: Discussionmentioning

confidence: 99%

Social inequalities and gender differences in healthcare management of acute ischaemic stroke in France

Naouri

Allain

Fery-Lemonier

et al. 2022

Euro J of Neurology

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“…In a previous study, the geographic accessibility of haemophilia patients in the Rhône‐Alpes region to hospital pharmacies underlined that approximately 72% of the study area was accessible to a hospital pharmacy in less than 30 min, 6 without considering the perception of patients and their caregivers who are impacted throughout their lives by the quality and availability of their treatment. Despite socio‐economic inequities 7,8 and geographic availability, 9,10 no study in France takes into account the perception of patients themselves regarding access to their treatment. However, the latter is important to take into account because it conditions the burden of the disease, particularly for disabling chronic diseases 8 …”

Section: What Is Known and Objectivementioning

confidence: 99%

PHAREO study: Perceived and observed accessibility to therapeutic drugs used for treating patients with inherited bleeding disorders

Chamouard

Fraticelli

Freyssenge

et al. 2022

Clinical Pharmacy Therapeu

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What Is Known and Objective The dispensing of clotting factor concentrates in hospital pharmacies imposes accessibility constraints on patients and their caregivers, thereby increasing the disease burden. Very few studies have addressed these issues so far in terms of individual perceptions and actual difficulties. The PHAREO study aims to report patient's perception of treatment accessibility and evaluate spatial accessibility. Methods The PHAREO study is an observational survey based on a questionnaire specifically designed for the study purpose in collaboration with patients' representatives in the second demographic and economic French region. Results and Discussion We collected 293 responses (participation rate of 64.1%) which show that 89.8% of respondents were either very or rather satisfied with regard to access to treatment. However, respondents reported difficulties in accessing the hospital pharmacy. The data also showed that 79.2% of respondents tended to over‐estimate travel time which was reported above their acceptable threshold for 39.2% of them. The main determinants of dissatisfaction were parental burden (OR 2.5 [1.3; 4.8], p = 0.008) and waiting time at the hospital pharmacy (OR 1.5 [1.1;2.0], p = 0.016, per 10 min increase). What Is New and Conclusion The PHAREO study provides subjective and objective data regarding satisfaction levels of persons with haemophilia and other coagulation deficiencies, with a high representativeness rate for patients on prophylaxis (87.5%). Both respondents and hospital pharmacists pled for an evolution of the current dispensing circuit to improve access to treatment and reduce the burden for patients. Currently, the community pharmacists are apart from the dispensing circuit. The authors propose improvements in the pathway of care for patients and their caregivers by including the community pharmacists alongside the hospital pharmacists in a centralized coordination scheme.

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“…Disparities in acute stroke treatments by socioeconomic status have been described, 7-10 but it is unclear whether these associations exist in jurisdictions with universal access to health care. While some studies reported no such association, 11,12 a recent study using data from the Danish Stroke Registry showed that low education, low income, and unemployment were associated with lower rates of treatment with thrombolysis or thrombectomy despite Denmark's universal health care system. 13…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Disparities in acute stroke treatments by socioeconomic status have been described, [7][8][9][10] but it is unclear whether these associations exist in jurisdictions with universal access to health care. While some studies reported no such association, 11,12 a recent study using data from the Danish Stroke Registry showed that low education, low income, and unemployment were associated with lower rates of treatment with thrombolysis or thrombectomy despite Denmark's universal health care system. 13 Moreover, accounting for clustering is crucial when examining this association because patients who visit the same hospital or reside in the same neighborhood might have a similar likelihood of receiving acute stroke treatments.…”

Section: Introductionmentioning

confidence: 99%

“…14,15 Prior investigations of socioeconomic disparities in IV thrombolysis or thrombectomy treatment have not routinely accounted for clustering. 7,8,10,11,13 We investigated whether differences in acute IV thrombolysis or thrombectomy treatments for ischemic stroke exist by socioeconomic status in Ontario, Canada, where residents have access to universal health care, and accounted for clustering at both the hospital and neighborhood levels.…”

Section: Introductionmentioning

confidence: 99%

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Association of Neighborhood Deprivation With Thrombolysis and Thrombectomy for Acute Stroke in a Health System With Universal Access

Taghdiri,

Vyas,

Kapral

et al. 2023

Neurology

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Background and Objectives:The association between socioeconomic status and acute ischemic stroke treatments remain uncertain, particularly in countries with universal healthcare systems. This study aimed to investigate the association between neighborhood-level material deprivation and the odds of receiving intravenous thrombolysis or thrombectomy for acute ischemic stroke within a single-payer, government-funded healthcare system.Methods:We conducted a population-based cohort study using linked administrative data from Ontario, Canada. The study involved all community-dwelling adult Ontario residents hospitalized with acute ischemic stroke between 2017 and 2022. Neighborhood-level material deprivation, measured in quintiles from least to most deprived, was our main exposure. We considered the receipt of thrombolysis or thrombectomy as the primary outcome. We used multivariable logistic regression models adjusted for baseline differences to estimate the association between material deprivation and outcomes. We performed a sensitivity analysis by additionally adjusting for hospital type at initial assessment. Further, we tested whether hospital type modified the associations between deprivation and outcomes.Results:Among 57,704 patients, those in the most materially deprived group (Quintile 5) were less likely to be treated with thrombolysis or thrombectomy compared to those in the least deprived group (Quintile 1), 16.6% vs 19.6%, adjusted odds ratio (aOR) 95% confidence interval 0.76 [0.63, 0.93]. The association was consistent when evaluating thrombolysis (13.0% vs 15.3%, aOR 0.78 [0.64, 0.96]) and thrombectomy (6.4 vs 7.8%, aOR 0.73 [0.59, 0.90]) separately. There were no statistically significant differences between the middle three quintiles and the least deprived group. These associations persisted after additional adjustment for hospital type and there was no interaction between material deprivation and hospital type (p-interaction > 0.1).Discussion:We observed disparities in the use of thrombolysis or thrombectomy for acute ischemic stroke by socioeconomic status despite access to universal healthcare. Targeted healthcare policies, public health messaging, and resource allocation are needed to ensure equitable access to acute stroke treatments for all patients.

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Are there socio-economic inequities in access to reperfusion therapy: The stroke 69 cohort

Cited by 4 publications

References 31 publications

Social inequalities and gender differences in healthcare management of acute ischaemic stroke in France

Social inequalities and gender differences in healthcare management of acute ischaemic stroke in France

PHAREO study: Perceived and observed accessibility to therapeutic drugs used for treating patients with inherited bleeding disorders

Association of Neighborhood Deprivation With Thrombolysis and Thrombectomy for Acute Stroke in a Health System With Universal Access

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