Department of Neurology, Semmelweis University, Budapest, Hungary.
MTA-SE Neuroepidemiological Research Group, Budapest, Hungary.
PLoS One. 2020 Oct 22;15(10):e0241059. doi: 10.1371/journal.pone.0241059. eCollection 2020.
Disadvantaged socioeconomic status is associated with higher stroke incidence and mortality, and higher readmission rate. We aimed to assess the effect of socioeconomic factors on case fatality, health related quality of life (HRQoL), and satisfaction with care of stroke survivors in the framework of the European Health Care Outcomes, Performance and Efficiency (EuroHOPE) study in Hungary, one of the leading countries regarding stroke mortality.
We evaluated 200 consecutive patients admitted for first-ever ischemic stroke in a single center and performed a follow-up at 3 months after stroke. We recorded pre- and post-stroke socioeconomic factors, and assessed case fatality, HRQoL and patient satisfaction with the care received. Stroke severity at onset was scored by the National Institutes of Health Stroke scale (NIHSS), disability at discharge from acute care was evaluated by the modified Rankin Score (mRS). To evaluate HRQoL and patient satisfaction with care we used the EQ-5D-5L, 15D and EORTC IN PATSAT 32 questionnaires.
At 3 months after stroke the odds of death was significantly increased by stroke severity (NIHSS, OR = 1.209, 95%CI: 1.125-1.299, p<0.001) and age (OR = 1.045, 95%CI: 1.003-1.089, p = 0.038). In a multiple linear regression model, independent predictors of HRQoL were age, disability at discharge, satisfaction with care, type of social dwelling after stroke, length of acute hospital stay and rehospitalization. Satisfaction with care was influenced negatively by stroke severity (Coef. = -1.111, 95%C.I.: -2.159- -0.062, p = 0.040), and positively by having had thrombolysis (Coef. = 25.635, 95%C.I.: 5.212-46.058, p = 0.016) and better HRQoL (Coef. = 22.858, 95%C.I.: 6.007-39.708, p = 0.009).
In addition to age, disability, and satisfaction with care, length of hospital stay and type of social dwelling after stroke also predicted HRQoL. Long-term outcome after stroke could be improved by reducing time spent in hospital, i.e. by developing home care rehabilitation facilities thus reducing the need for readmission to inpatient care.
社会经济地位较低与更高的卒中发病率和死亡率以及更高的再入院率相关。我们旨在评估社会经济因素对匈牙利卒中幸存者病死率、健康相关生活质量（HRQoL）和护理满意度的影响，该研究是在欧洲卫生保健结果、绩效和效率（EuroHOPE）研究框架内进行的，匈牙利是卒中死亡率最高的国家之一。
我们评估了 200 名在单中心因首次缺血性卒中住院的连续患者，并在卒中后 3 个月进行了随访。我们记录了卒中前和卒中后的社会经济因素，并评估了病死率、HRQoL 和患者对所接受护理的满意度。卒中发作时的严重程度采用国立卫生研究院卒中量表（NIHSS）评分，急性治疗出院时的残疾程度采用改良 Rankin 评分（mRS）评估。为了评估 HRQoL 和患者对护理的满意度，我们使用了 EQ-5D-5L、15D 和 EORTC IN PATSAT 32 问卷。
卒中后 3 个月，病死率显著增加与卒中严重程度（NIHSS，OR=1.209，95%CI：1.125-1.299，p<0.001）和年龄（OR=1.045，95%CI：1.003-1.089，p=0.038）相关。在多元线性回归模型中，HRQoL 的独立预测因素为年龄、出院时的残疾程度、护理满意度、卒中后社会居住类型、急性住院时间和再入院。护理满意度与卒中严重程度呈负相关（Coef.=-1.111，95%CI：-2.159- -0.062，p=0.040），与溶栓治疗呈正相关（Coef.=25.635，95%CI：5.212-46.058，p=0.016）和更好的 HRQoL 呈正相关（Coef.=22.858，95%CI：6.007-39.708，p=0.009）。
除年龄、残疾和护理满意度外，卒中后住院时间和社会居住类型也可预测 HRQoL。通过减少住院时间，即通过发展家庭护理康复设施，减少对住院治疗的需求，从而减少再入院率，可改善卒中后的长期预后。
