Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran.
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Neuroepidemiology. 2019;53(1-2):27-31. doi: 10.1159/000494885. Epub 2019 Apr 16.
Little is known about the association between socioeconomic status and long-term stroke outcomes, particularly in low- and middle-income countries.
Patients were recruited from the Mashhad Stroke Incidence Study in Iran. We identified different socioeconomic variables including the level of education, occupation, household size, and family income. Residential location according to patient's neighbourhood was classified into less privileged area (LPA), middle privileged area and high privileged area (HPA). Using Cox regression, competing risk analysis and logistic regression models, we determined the association between socioeconomic status and 1- and 5-year stroke outcomes. Generalized linear model was used for adjusting associated variables for stroke severity.
Six hundred twenty-four patients with first-ever stroke were recruited in this study. Unemployment prior to stroke was associated with an increased risk of 1- and 5-year post-stroke mortality (1 year: adjusted hazard ratio [aHR] 3.3; 95% CI 1.6-7.06: p = 0.001; 5 years: aHR 2.1; 95% CI 1.2-3.6: p = 0.007). The 5-year mortality rate was higher in less educated patients (<12 years) as compared to those with at least 12 years of schooling (aHR 1.84; 95% CI 1.05-3.23: p = 0.03). Patients living in LPA compared to those living in HPAs experienced a more severe stroke at admission (aB 3.84; 95% CI 0.97-6.71, p = 0.009) and disabling stroke at 1 year follow-up (OR 6.1; 95% CI 1.3-28.4; p = 0.02).
A comprehensive stroke strategy should also address socioeconomic disadvantages.
关于社会经济地位与长期卒中结局之间的关系，人们知之甚少，特别是在低收入和中等收入国家。
本研究的参与者均来自伊朗马什哈德卒中发生率研究。我们确定了不同的社会经济变量，包括教育水平、职业、家庭规模和家庭收入。根据患者所在社区，居住位置被分为贫困区（LPA）、中等特权区和高特权区（HPA）。使用 Cox 回归、竞争风险分析和逻辑回归模型，我们确定了社会经济地位与 1 年和 5 年卒中结局之间的关联。使用广义线性模型对卒中严重程度相关变量进行调整。
本研究共纳入 624 例首发卒中患者。卒中前失业与 1 年和 5 年卒中后死亡率增加相关（1 年：调整后危险比[aHR] 3.3；95%置信区间 [CI] 1.6-7.06：p = 0.001；5 年：aHR 2.1；95% CI 1.2-3.6：p = 0.007）。与接受至少 12 年教育的患者相比，受教育程度较低（<12 年）的患者 5 年死亡率更高（aHR 1.84；95% CI 1.05-3.23：p = 0.03）。与居住在 HPA 的患者相比，居住在 LPA 的患者入院时卒中更严重（aB 3.84；95% CI 0.97-6.71，p = 0.009），1 年随访时致残性卒中的发生率更高（OR 6.1；95% CI 1.3-28.4；p = 0.02）。
全面的卒中策略也应解决社会经济劣势问题。
