Division of Health and Social Care Research, King's College London, London, UK.
Division of Health and Social Care Research, King's College London, London, UK National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
J Neurol Neurosurg Psychiatry. 2014 Dec;85(12):1294-300. doi: 10.1136/jnnp-2013-306413. Epub 2014 Apr 13.
Socioeconomic deprivation (SED) is associated with increased mortality after stroke, however, its associations with stroke care remains uncertain. We assessed the SED impacts on acute and long-term stroke care, and examined their ethnic differences and secular trends.
We used data from 4202 patients with first-ever stroke (mean age 70.1 years, 50.4% male, 20.4% black), collected by a population-based stroke register in South London, England from 1995 to 2010. Carstairs deprivation score was measured for each patient, taking the 1st as the least deprived and the 2nd to 5th quintiles as SED, and was related to 20 indicators of care in multivariate logistic regression models.
Patients with SED had 29% and 35% statistically significant reductions in odds of being admitted to hospital and having swallow tests, respectively. The multivariate adjusted odds ratio (OR) for receiving five indicators of acute stroke care was 0.81 (95% CI 0.72 to 0.92). It was 0.76 (0.58 to 0.99) in black patients and 0.82 (0.71 to 0.96) in white patients; and 0.70 (0.58 to 0.84) in patients with stroke occurring before 2001 and 0.89 (0.75 to 1.05) since 2001. SED was further associated with receipt of some stroke care during 5 years of follow-up, including atrial fibrillation medication (0.63, 0.48 to 0.83), and in black patients physiotherapy and occupational therapy (0.32, 0.11 to 0.92).
Stroke healthcare inequalities in England exist for some important indicators, although overall it has improved over time. The impact of SED may be stronger in black patients than in white patients. Further efforts are required to achieve stroke care equality.
社会经济剥夺（SED）与中风后死亡率增加有关，但与中风护理的关联尚不确定。我们评估了 SED 对急性和长期中风护理的影响，并检查了它们的种族差异和时间趋势。
我们使用了 1995 年至 2010 年在英格兰伦敦南部的一个基于人群的中风登记处收集的 4202 名首次中风患者（平均年龄 70.1 岁，50.4%为男性，20.4%为黑人）的数据。为每位患者测量了卡斯特斯剥夺评分，将第 1 位评为最不贫困，第 2 至第 5 五分位数评为 SED，并在多元逻辑回归模型中与 20 项护理指标相关。
SED 患者住院和接受吞咽测试的几率分别降低了 29%和 35%。接受 5 项急性中风护理指标的多变量调整后比值比（OR）为 0.81（95%CI 0.72 至 0.92）。在黑人患者中为 0.76（0.58 至 0.99），在白人患者中为 0.82（0.71 至 0.96）；在 2001 年之前发生中风的患者中为 0.70（0.58 至 0.84），在 2001 年之后发生中风的患者中为 0.89（0.75 至 1.05）。SED 还与 5 年随访期间接受某些中风护理相关，包括心房颤动药物治疗（0.63，0.48 至 0.83），以及在黑人患者中接受物理治疗和职业治疗（0.32，0.11 至 0.92）。
英格兰存在一些重要指标的中风医疗保健不平等现象，尽管总体而言，随着时间的推移，这种情况有所改善。SED 的影响在黑人患者中可能比在白人患者中更强。需要进一步努力实现中风护理平等。
