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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study

Authors: Valeria Belleudi, Paolo Sciattella, Nera Agabiti, Mirko Di Martino, Riccardo Di Domenicantonio, Marina Davoli, Danilo Fusco

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

The reasons for socioeconomic inequity in stroke mortality are not well understood. The aim of this study was to explore the role of ischemic stroke care-pathways on the association between education level and one-year survival after hospital admission.

Methods

Hospitalizations for ischemic stroke during 2011/12 were selected from Lazio health data. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. The association between education level and mortality after stroke was studied for acute and post-acute phases using multilevel logistic models (Odds Ratio (OR)). Different scenarios of quality care-pathways were identified considering hospital performance, access to rehabilitation and drug treatment post-discharge. The probability to survive to acute and post-acute phases according to education level and care-pathway scenarios was estimated for a “mean-severity” patient. One-year survival probability was calculated as the product of two probabilities. For each scenario, the 1-year survival probability ratio, university versus elementary education, and its Bootstrap Confidence Intervals (95 % BCI) were calculated.

Results

We identified 9,958 patients with ischemic stroke, 53.3 % with elementary education level and 3.2 % with university. The mortality was 14.9 % in acute phase and 14.3 % in post-acute phase among survived to the acute phase. The adjusted mortality in acute and post-acute phases decreased with an increase in educational level (OR = 0.90 p-trend < 0.001; OR = 0.85 p-trend < 0.001). For the best care-pathway, the one-year survival probability ratio was 1.06 (95 % BCI = 1.03–1.10), while it was 1.17 (95 % BCI = 1.09–1.25) for the worst.

Conclusions

Education level was inversely associated with mortality both in acute and post-acute phases. The care-pathway reduces but does not eliminate 1-year survival inequity.
Literature
1.
Arrich J, Lalouschek W, Müllner M. Influence of socioeconomic status on mortality after stroke: retrospective cohort study. Stroke. 2005;36:310–4.CrossRefPubMed
2.
Cesaroni G, Agabiti N, Forastiere F, Perucci CA. Socioeconomic differences in stroke incidence and prognosis under a universal healthcare system. Stroke. 2009;40:2812–9.CrossRefPubMed
3.
Ahacic K, Trygged S, Kåreholt I. Income and education as predictors of stroke mortality after the survival of a first stroke. Stroke Res Treat. 2012;2012:983145.PubMedPubMedCentral
4.
Addo J, Ayerbe L, Mohan KM, Crichton S, Sheldenkar A, Chen R, et al. Socioeconomic status and stroke: an updated review. Stroke. 2012;43:1186–91.CrossRefPubMed
5.
Andersen KK, Steding-Jessen M, Dalton SO, Olsen TS. Socioeconomic position and incidence of ischemic stroke in Denmark 2003–2012. A nationwide hospital-based study. J Am Heart Assoc. 2014;16:3.
6.
Nordahl H, Lange T, Osler M, Diderichsen F, Andersen I, Prescott E, et al. Education and cause-specific mortality: the mediating role of differential exposure and vulnerability to behavioral risk factors. Epidemiology. 2014;25:389–96.CrossRefPubMed
7.
Saposnik G, Jeerakathil T, Selchen D, Baibergenova A, Hachinski V, Kapral MK, Stroke Outcome Research Canada Working Group. Socioeconomic status, hospital volume, and stroke fatality in Canada. Stroke. 2008;39:3360–6.CrossRefPubMed
8.
Langagergaard V, Palnum KH, Mehnert F, Ingeman A, Krogh BR, Bartels P, et al. Socioeconomic differences in quality of care and clinical outcome after stroke: a nationwide population-based study. Stroke. 2011;42:2896–902.CrossRefPubMed
9.
Huang K, Khan N, Kwan A, Fang J, Yun L, Kapral MK. Socioeconomic status and care after stroke: results from the Registry of the Canadian Stroke Network. Stroke. 2013;44:477–82.CrossRefPubMed
10.
Lindmark A, Glader EL, Asplund K, Norrving B, Eriksson M, Riks-Stroke Collaboration. Socioeconomic disparities in stroke case fatality--Observations from Riks-Stroke, the Swedish stroke register. Int J Stroke. 2014;9:429–36.CrossRefPubMed
11.
Royal College of Physicians, National Collaborating Centre for Chronic Conditions (UK). Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA). London: Royal College of Physicians of London; 2008.
12.
Dreyer NA, Schneeweiss S, McNeil BJ, Berger ML, Walker AM, Ollendorf DA, et al. GRACE principles: recognizing high-quality observational studies of comparative effectiveness. Am J Manag Care. 2010;16:467–71.PubMed
13.
Saposnik G, Hassan KA, Selchen D, Fang J, Kapral MK, Smith EE. Stroke unit care: does ischemic stroke subtype matter? Int J Stroke. 2011;6:244–50.CrossRefPubMed
14.
Serna-Candel C, Matías-Guiu J. From the evidence to the organisation of stroke care. Neurologia. 2011;26:507–9.CrossRefPubMed
15.
Purvis T, Moss K, Denisenko S, Bladin C, Cadilhac DA. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators. J Multidiscip Healthc. 2014;7:389–400.PubMedPubMedCentral
16.
Saposnik G, Baibergenova A, O’Donnell M, Hill MD, Kapral MK, Hachinski V, Stroke Outcome Research Canada (SORCan) Working Group. Hospital volume and stroke outcome: does it matter? Neurology. 2007;69:1142–51.CrossRefPubMed
17.
Hastie T, Tibshirani R, and Friedman J. The Elements of Statistical Learning: Data Mining, Inference, and Prediction. Second Edition. Springer Series in Statistics. California (USA): Springer-Verlag; 2009.
18.
Beauchamp A, Peeters A, Wolfe R, Turrell G, Harriss LR, Giles GG, et al. Inequalities in cardiovascular disease mortality: the role of behavioural, physiological and social risk factors. J Epidemiol Community Health. 2010;64:542–8.CrossRefPubMed
19.
Kershaw KN, Droomers M, Robinson WR, Carnethon MR, Daviglus ML, Monique Verschuren WM. Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study. Eur J Epidemiol. 2013;28:807–14.CrossRefPubMed
20.
Kuper H, Adami HO, Theorell T, Weiderpass E. The socioeconomic gradient in the incidence of stroke: a prospective study in middle-aged women in Sweden. Stroke. 2007;38:27–33.CrossRefPubMed
21.
Brown P, Guy M, Broad J. Individual socio-economic status, community socio-economic status and stroke in New Zealand: a case control study. Soc Sci Med. 2005;61:1174–88.CrossRefPubMed
22.
McKevitt C, Coshall C, Tilling K, Wolfe C. Are there inequalities in the provision of stroke care? Analysis of an inner-city stroke register. Stroke. 2005;36:315–20.CrossRefPubMed
23.
Sandercock PA1, Counsell C, Kane EJ. Anticoagulants for acute ischaemic stroke. Cochrane Database Syst Rev. 2015;12:CD000024.
24.
Bath PM1, Krishnan K. Interventions for deliberately altering blood pressure in acute stroke. Cochrane Database Syst Rev. 2014;28:CD000039.
25.
Squizzato A1, Romualdi E, Dentali F, Ageno W. Statins for acute ischemic stroke. Cochrane Database Syst Rev. 2011;10:CD007551.
26.
Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. Consortium for the Europen review of social determinants of health and the health divide. WHO european review of social determinants of health and the health divide. Lancet. 2012;15(380):1011–29.CrossRef
27.
Marí-Dell’Olmo M, Gotsens M, Palència L, Burström B, Corman D, Costa G, et al. Socioeconomic inequalities in cause-specific mortality in 15 European cities. J Epidemiol Community Health. 2015;69:432–41.CrossRefPubMed
28.
Agabiti N, Pirani M, Schifano P, Cesaroni G, Davoli M, Bisanti L, Italian Study Group on Inequalities in Health Care, et al. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy. BMC Public Health. 2009;11(9):457.CrossRef
29.
Colais P, Agabiti N, Fusco D, Pinnarelli L, Sorge C, Perucci CA, et al. Inequality in 30-day mortality and the wait for surgery after hip fracture: the impact of the regional health care evaluation program in Lazio (Italy). Int J Qual Health Care. 2013;25:239–47.CrossRefPubMed
30.
Appelros P, Stegmayr B, Terént A. A review on sex differences in stroke treatment and outcome. Acta Neurol Scand. 2010;121:359–69.CrossRefPubMed
31.
Ventura M, Colais P, Fusco D, Agabiti N, Cesaroni G, Davoli M. Information on educational level from hospital discharge register: an analysis of validity. Epidemiol Prev. 2013;37:289–96.PubMed
32.
Belleudi V, Fusco D, Kirchmayer U, Agabiti N, Di Martino M, Narduzzi S, et al. Definition of patients treated with evidence based drugs in absence of prescribed daily doses: the example of acute myocardial infarction. Pharmacoepidemiol Drug Saf. 2011;20:169–76.CrossRefPubMed
Metadata
Title
Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study
Authors
Valeria Belleudi
Paolo Sciattella
Nera Agabiti
Mirko Di Martino
Riccardo Di Domenicantonio
Marina Davoli
Danilo Fusco
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3019-8

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