Pan Yuesong, Chen Ruoling, Li Zixiao, Li Hao, Zhao Xingquan, Liu Liping, Wang Chunxue, Wang Yilong, Wang Yongjun
From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (Y.P., Z.L., H.L., X.Z., L.L., C.W., Yilong Wang, Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.P., Z.L., H.L., X.Z., L.L., C.W., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Y.P., Z.L., H.L., X.Z., L.L., C.W., Yilong Wang, Yongjun Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Y.P., Z.L., H.L., X.Z., L.L., C.W., Yilong Wang, Yongjun Wang); Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.P.); and Centre for Health and Social Care Improvement, Faculty of Education Health and Wellbeing, University of Wolverhampton, United Kingdom (R.C.).
Stroke. 2016 Nov;47(11):2836-2842. doi: 10.1161/STROKEAHA.116.013292. Epub 2016 Oct 6.
The association of socioeconomic status (SES) with quality of stroke care is not well understood, and few studies have examined the association with different indicators of SES simultaneously. We assessed the impacts of low levels of education, occupation, and income on the quality of stroke care.
We examined data from the China National Stroke Registry recording consecutive stroke patients between September 2007 and August 2008. Baseline low SES was measured using educational level <6 years, occupation as manual workers or no job, and average family income per capita at ≤¥1000 per month. Compliance with 11 performances was summarized in a composite score defined as the proportion of all needed care given. Poor quality of care was defined as having a composite score of 0.71 or less.
Among 12 270 patients with ischemic stroke, 38.6% had <6 educational years, 37.6% had manual workers/no job, and 34.7% had income ≤¥1000 per month. There was an increased chance of receiving poor quality of care in patients with low education (adjusted odds ratio 1.15, 95% confidence interval 1.03-1.28), low occupation (adjusted odds ratio 1.16, 95% confidence interval 1.01-1.32), and low income (adjusted odds ratio 1.18, 95% confidence interval 1.06-1.30), respectively. People with low SES had poor performances on some aspects of care quality. Combined effects existed among these SES indicators; those with low SES from all 3 indicators had the poorest quality of care.
There was a social gradient in the quality of stroke care. Continuous efforts of socioeconomic improvement will increase the quality of acute stroke care.
社会经济地位（SES）与卒中护理质量之间的关联尚未得到充分理解，并且很少有研究同时考察SES的不同指标之间的关联。我们评估了低教育水平、职业和收入对卒中护理质量的影响。
我们研究了中国国家卒中登记处2007年9月至2008年8月期间连续收治的卒中患者的数据。基线低SES的衡量标准为教育水平<6年、职业为体力劳动者或无工作、家庭人均月收入≤1000元。对11项表现的依从性总结为一个综合评分，定义为所提供的所有所需护理的比例。护理质量差定义为综合评分为0.71或更低。
在12270例缺血性卒中患者中，38.6%的患者教育年限<6年，37.6%的患者为体力劳动者/无工作，34.7%的患者收入≤1000元/月。低教育水平（调整后的优势比1.15，95%置信区间1.03 - 1.28）、低职业（调整后的优势比1.16，95%置信区间1.01 - 1.32）和低收入（调整后的优势比1.18，95%置信区间1.06 - 1.30）的患者接受低质量护理的可能性分别增加。SES低的人群在护理质量的某些方面表现较差。这些SES指标之间存在综合效应；来自所有3个指标的低SES人群护理质量最差。
卒中护理质量存在社会梯度。持续改善社会经济状况将提高急性卒中护理质量。
