Department of Neurology, Aarhus University Hospital, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.).
Danish Center for Clinical Health Services Research, Aalborg University, Denmark (P.C., S.P.J.).
Stroke. 2022 Jul;53(7):2307-2316. doi: 10.1161/STROKEAHA.121.037687. Epub 2022 May 17.
Reperfusion therapies (thrombolysis and thrombectomy) are of paramount importance for the recovery after ischemic stroke. We aimed to investigate if socioeconomic status (SES) was associated with the chance of receiving reperfusion therapy for ischemic stroke in a country with tax-funded health care.
This nationwide register-based cohort study included patients with ischemic stroke registered in the Danish Stroke Registry between 2015 and 2018. SES was determined by prestroke educational attainment, income level, and employment status. Data on SES was obtained from Statistics Denmark and linked on an individual level with data from the Danish Stroke Registry. Risk ratios (RR) for receiving reperfusion therapies were calculated using univariate and multivariable Poisson regression with robust variance.
A total of 37 187 ischemic stroke patients were included. Low SES, as defined by education, income and employment status, was associated with lower treatment rates. The socioeconomic gradient was most pronounced according to employment status, with intravenous thrombolysis rates of 23.7% versus 15.8%, and thrombectomy rates of 5.1% versus 2.8% for employed versus unemployed patients. When the analyses were restricted to patients with timely hospital arrival, and adjusted for age, sex and immigrant status, low SES according to income and employment remained unfavorable for the likelihood of receiving intravenous thrombolysis: adjusted RR, 0.90 (95% CI, 0.86-0.95) for low versus high income, and adjusted RR, 0.77 (95% CI, 0.71-0.84) for unemployed versus employed patients. Similarly, low SES according to income and employment status remained unfavorable for the likelihood of receiving thrombectomy: adjusted RR, 0.83 (95% CI, 0.72-0.95) for low versus high income and adjusted RR, 0.68 (95% CI, 0.53-0.88) for unemployed versus employed patients.
Socioeconomic inequalities in reperfusion treatment rates among ischemic stroke patients prevail, even in a country with tax-funded universal health care.
再灌注治疗（溶栓和血栓切除术）对缺血性卒中后的恢复至关重要。我们旨在研究在一个拥有税收资助的全民医保的国家，社会经济地位（SES）是否与缺血性卒中患者接受再灌注治疗的机会相关。
这是一项全国范围内基于登记的队列研究，纳入了 2015 年至 2018 年期间在丹麦卒中登记处登记的缺血性卒中患者。SES 通过发病前的教育程度、收入水平和就业状况来确定。SES 数据来自丹麦统计局，并通过个体水平与丹麦卒中登记处的数据进行链接。使用单变量和多变量泊松回归（具有稳健方差）计算接受再灌注治疗的风险比（RR）。
共纳入 37187 例缺血性卒中患者。SES 低，定义为教育、收入和就业状况低，与治疗率低相关。根据就业状况，社会经济梯度最为显著，接受静脉溶栓治疗的患者比例分别为 23.7%和 15.8%，接受血栓切除术的患者比例分别为 5.1%和 2.8%。当分析仅限于及时到达医院的患者，并根据年龄、性别和移民身份进行调整时，SES 低（根据收入和就业状况）仍然不利于接受静脉溶栓治疗的可能性：调整后的 RR，低收入与高收入相比为 0.90（95%CI，0.86-0.95），与就业相比为 0.77（95%CI，0.71-0.84）。同样，SES 低（根据收入和就业状况）仍然不利于接受血栓切除术的可能性：调整后的 RR，低收入与高收入相比为 0.83（95%CI，0.72-0.95），与就业相比为 0.68（95%CI，0.53-0.88）。
即使在一个拥有税收资助的全民医保的国家，缺血性卒中患者的再灌注治疗率也存在社会经济不平等。
