Social deprivation and stroke severity on admission: a French cohort study in Burgundy and the West Indies – Guyana region

Abstract

Social deprivation was associated with a more severe clinical presentation in patients with stroke. These findings may contribute to the worse outcome after stroke in deprived patients, and underline the need for strategies to reduce social inequalities for stroke.

Social deprivation among socio-economic contrasted french areas: Using item response theory analysis to assess differential item functioning of the EPICES questionnaire in stroke patients

“…However EPICES also have strong points: it is a short questionnaire, designed to be filled in a clinical context with limited time, which can also be useful in a research context. It was used successfully to analyse relationship between low socioeconomic status and health [14][15][16][17]35]. As such it seems worthy to be included in comparisons with other scales [36][37][38], before choosing a tool to measure precariousness or social deprivation at the individual level.…”

“…The INDIA ("INégalités sociales et pronostic des accidents vasculaires cérébraux à DIjon et en Antilles-Guyane") study is a French multicentre prospective cohort which aims to evaluate the impact of social inequalities on stroke characteristics and prognosis [17]. Patients were recruited between June 2011 and October 2014, from six centres located in three geographical areas chosen for their socioeconomic disparities (Dijon, Burgundy; Fort-de-France and Pointeà-Pitre, FWI; Cayenne, Saint Laurent du Maroni and Kourou, FG), including three neurology departments of university hospital and three emergency department.…”

“…A short questionnaire was devised to rapidly assess the level of precariousness at the individual level, in a large sample of the French population [5,12,13]: the EPICES score ("Évaluation de la Précarité et des Inégalités de santé dans les Centres d'Examen de Santé"), published in 2006. The aim of EPICES was to detect the level of precariousness in people consulting in health centres, but it was also used in epidemiological studies [14][15][16][17]. This score was developed using classical test theory and validated against other measurements in a heterogeneous population [18,19].…”

“…Thus, if a DIF is present for a covariate (age, area of residence, gender) in a questionnaire, comparisons between results for each category of this covariate are invalid. We took the opportunity of the INDIA study on the prognosis following stroke in metropolitan France, the French West Indies (FWI) and French Guiana (FG) [17], to evaluate the DIF of each item of the EPICES questionnaire according to geographical areas, gender and age categories.…”

Progress in neurology 2017–2018

“…Stroke remains the most common problem for neurologists to diagnose and treat . Preventative measures, such as control of hypertension, reduction in smoking and treatment of hyperlipidaemia, have made a significant contribution to preventing and delaying stroke onset.…”