Socioeconomic Status and the Quality of Acute Stroke Care

Pan, Yuesong; Chen, Ruoling; Li, Zixiao; Li, Hao; Wang, Wenjuan; Liu, Liping; Wang, Chunxue; Wang, Yilong; Wang, Yongjun

doi:10.1161/strokeaha.116.013292

Cited by 18 publications

(15 citation statements)

References 34 publications

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“…Other vascular risk factors included current or previous smoking and moderate or heavy alcohol consumption (≥ 2 standardized alcohol drinks per day) and body mass index (BMI). Socioeconomic status (SES) included educational level, occupational class, and personal income level [ 10 ]. Occupational class was classified based on the main job types at admission.…”

Section: Methodsmentioning

confidence: 99%

Association between marriage and outcomes in patients with acute ischemic stroke

Liu

Wang

et al. 2018

J Neurol

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BackgroundsThe previous studies on the association between marital status and stroke outcomes were rare. Furthermore, the existing studies mostly focused on the protective effect of marriage on survival. We conducted the study to evaluate the association between marital status and adverse stroke outcomes in patients with AIS based on China national stroke registry.MethodsThis was a multicenter, prospective cohort study of patients with AIS. Patients were classified into two groups based on marital status at admission: married and unmarried. The primary outcomes included all-cause mortality, stroke recurrence, combined endpoint, and stroke disability. Stroke disability was defined as modified Rankin Scale of 2–6.ResultsOf 12,118 patients, 1220 were unmarried and 10,898 married. Unmarried patients had higher proportion of 1-year post-stroke events than married patients did. As compared with being unmarried, the adjusted odds ratios with 95% confidence interval of being married for outcomes were as follows: 0.70 (0.58–0.84) for all-cause mortality, 0.78 (0.66–0.91) for stroke recurrence, 0.77 (0.66–0.90) for combined endpoint, and 0.75 (0.65–0.88) for stroke disability. Interactions between marital status and education were significant for all outcomes except for stroke disability.ConclusionsMarital status was associated with all adverse stroke outcomes in patients with acute ischemic stroke, especially in those with middle-school education.Electronic supplementary materialThe online version of this article (10.1007/s00415-018-8793-z) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Association between marriage and outcomes in patients with acute ischemic stroke

Liu

Wang

et al. 2018

J Neurol

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“…Data regarding medications during hospitalization and at discharge were collected through medical records and data regarding medications during follow-up visits were collected by interviews between site investigators (neurologists) and patients. We used five evidence-based interventions 17 to document the performance of secondary prevention care of ischemic cerebrovascular event for each patient. It includes (1) antithrombotic treatment for patients who had no contraindications; (2) statins use for pa-tients with dyslipidemia or LDL-C ≥100 mg/dL who had no contraindications; (3) antihypertensive agents use for patients with hypertension who had no contraindications; (4) antidiabetic agents use for patients with diabetes mellitus who had no contraindications; and (5) anticoagulant agents use for atrial fibrillation who had no contraindications.…”

Section: Secondary Prevention Carementioning

confidence: 99%

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Pan

et al. 2021

J Stroke

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Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

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“…Similar findings apply to the prognosis after a stroke in relation to recurrence,9 poststroke disability,10 and survival 8,11. Although few researchers have investigated inequality in the provision of stroke care, a social gradient has been identified in the likelihood of receiving evidence-based stroke care even in countries with free access to health care 8,12. Low income, lower educational level, and receipt of a disability pension have been found to be associated with a smaller chance of receiving care in accordance with clinical guideline recommendations 13–18…”

Section: Introductionmentioning

confidence: 72%

<p>Socioeconomic Status And Acute Stroke Care: Has The Inequality Gap Been Closed?</p>

Hyldgård¹,

Støvring²,

Søgaard³

2019

CLEP

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PurposeSocioeconomic inequality in stroke care occurs even in countries with free access to health care. We aimed to investigate the association between socioeconomic status and guideline-recommended acute care in Denmark during the last decade.DesignWe conducted a nationwide, population-based study. We used household income, employment status, and education as markers of socioeconomic status and adjusted the results for relevant clinical covariates. We used weighted linear regression models to analyse empirical log odds of performance measure fulfillment at patient level.SettingPublic hospitals in Denmark.ParticipantsA total of 110,848 consecutive stroke patients discharged between 2004 and 2014.Intervention(s)Acute stroke care according to clinical guidelines.Main outcome measure(s)Guideline-recommended care was defined in two ways based on clinical performance measures: the percentage of fulfilled measures used throughout the study period (m=8) (model 1) and the percentage of fulfilled measures used at the time of discharge (m=8 to 16) (model 2).ResultsCompared with high family income, low income was negatively associated with the guideline-recommended care; odds ratios (95% CI) were 0.89 (0.85–0.93) in model 1 and 0.81 (0.77–0.85) in model 2. Low family income was negatively associated with fulfillment of 14 of the 16 performance measures. In general, the percentage of performance measures fulfilled increased over time from 70% (95% CI 63–76) to 85% (95% CI 83–87).ConclusionSocioeconomic inequality in guideline-recommended stroke care remains despite overall improvements in a setting with free access to care and systematic monitoring of health care quality.

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Socioeconomic Status and the Quality of Acute Stroke Care

Cited by 18 publications

References 34 publications

Association between marriage and outcomes in patients with acute ischemic stroke

Association between marriage and outcomes in patients with acute ischemic stroke

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

<p>Socioeconomic Status And Acute Stroke Care: Has The Inequality Gap Been Closed?</p>

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