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

Authors


  • Conflicts of interest: The authors have no conflicts of interest related to this article.
  • Funding: This study was supported by grants from the Swedish Council for Working Life and Social Research (grant no. 2011-0657), the Swedish Research Council (2011-2395) and from the VINNVÅRD research program. Riks-Stroke is funded by the National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions.

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 (9·8%) 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.

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