Pan Yuesong, Song Tian, Chen Ruoling, Li Hao, Zhao Xingquan, Liu Liping, Wang Chunxue, Wang Yilong, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China China National Clinical Research Center for Neurological Diseases, Beijing, China Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China China National Clinical Research Center for Neurological Diseases, Beijing, China Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
Int J Stroke. 2016 Jul;11(5):557-64. doi: 10.1177/1747493016641121. Epub 2016 Mar 24.
Previous findings of the association between socioeconomic deprivation and mortality after ischemic stroke are inconsistent. There is a lack of data on the association with combined low education, occupational class, and income. We assessed the associations of three indicators with mortality.
We examined data from the China National Stroke Registry, recording all stroke patients occurred between September 2007 and August 2008. Baseline socioeconomic deprivation was measured using low levels of education at <6 years, occupation as manual laboring, and average family income per capita at ≤¥1000 per month. A total of 12,246 patients with ischemic stroke were analyzed.
In a 12-month follow-up 1640 patients died. After adjustment for age, sex, cardiovascular risk factors, severity of stroke, and prehospital medications, odds ratio for mortality in patients with low education was 1.25 (95%CI 1.05-1.48), manual laboring 1.37 (1.09-1.72), and low income 1.19 (1.03-1.37). Further adjustment for acute care and medications in and after hospital made no substantial changes in these odds ratios, except a marginal significant odds ratio for low income (1.15, 0.99-1.33). The odds ratio for low income was 1.27 (1.01-1.60) within patients with high education. Compared with no socioeconomic deprivation, the odds ratio in patients with socioeconomic deprivation determined by any one indicator was 1.33 (1.11-1.59), by any two indicators 1.36 (1.10-1.69), and by all three indicators 1.56 (1.23-1.97).
There are significant inequalities in survival after ischemic stroke in China in terms of social and material forms of deprivation. General socioeconomic improvement, targeting groups at high risk of mortality is likely to reduce inequality in survival after stroke.
先前关于社会经济剥夺与缺血性中风后死亡率之间关联的研究结果并不一致。缺乏关于低教育水平、职业阶层和收入综合关联的数据。我们评估了这三个指标与死亡率的关联。
我们研究了中国国家卒中登记的数据，记录了2007年9月至2008年8月期间发生的所有中风患者。使用低于6年的低教育水平、体力劳动职业以及每月人均家庭收入≤1000元来衡量基线社会经济剥夺情况。总共对12246例缺血性中风患者进行了分析。
在12个月的随访中，1640例患者死亡。在调整了年龄、性别、心血管危险因素、中风严重程度和院前用药情况后，低教育水平患者的死亡比值比为1.25（95%置信区间1.05 - 1.48），体力劳动者为1.37（1.09 - 1.72），低收入者为1.19（1.03 - 1.37）。进一步调整住院期间及出院后的急性护理和用药情况后，这些比值比没有实质性变化，除了低收入的比值比有轻微显著变化（1.15，0.99 - 1.33）。高教育水平患者中低收入的比值比为1.27（1.01 - 1.60）。与无社会经济剥夺相比，由任何一个指标确定的社会经济剥夺患者的比值比为1.33（1.11 - 1.59），由任何两个指标确定的为1.36（1.10 - 1.69），由所有三个指标确定的为1.56（1.23 - 1.97）。
在中国，缺血性中风后的生存情况在社会和物质剥夺形式方面存在显著不平等。针对高死亡风险群体进行总体社会经济改善可能会减少中风后生存的不平等现象。
