Neighborhood income and stroke care and outcomes
Neighborhood income and stroke care and outcomes
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DOI：
10.1212/wnl.0b013e31826aac9b
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发表时间：
2012-09-01
期刊：
影响因子：
9.9
通讯作者：
Anderson, Geoffrey M.
中科院分区：
文献类型：
--
作者：
Kapral, Moira K.;Fang, Jiming;Anderson, Geoffrey M.
目的：评估可能导致低收入地区人群中风病死率增加的因素。方法：我们对2002年4月1日至2003年3月31日、2004年4月1日至2005年3月31日期间在加拿大安大略省153家急诊医院就诊的所有卒中或TIA患者进行了一项基于人群的样本队列研究。2005.以收入五分位数衡量的社会经济地位是根据社区收入中位数估算的。在7,816例患者的研究样本中，我们确定了1年死亡率的分组收入五分位数和多变量分析，以评估是否在生存的差异是由心血管危险因素，中风严重程度，中风管理，或其他预后factors.Results解释：有没有显着的梯度跨收入组中风严重程度或中风管理。然而，即使在调整了年龄、性别、卒中类型和严重程度、共病情况、医院和医生特征以及护理过程后，最低收入组的1年死亡率仍高于最高收入组（低收入组与高收入组的校正风险比为1.18; 95%置信区间为1.03 ~ 1.29）。在安大略，与最不富裕的地区相比，最富裕地区的人中风后1年生存率更高，这只能部分解释为年龄，性别，共病状况和其他基线风险因素。神经病学（R）2012;79：1200-1207
Objective: To evaluate factors that may contribute to the increased stroke case fatality rates observed in individuals from low-income areas.Methods: We conducted a cohort study on a population-based sample of all patients with stroke or TIA seen at 153 acute care hospitals in the province of Ontario, Canada, between April 1, 2002, and March 31, 2003, and April 1, 2004, and March 31, 2005. Socioeconomic status measured as income quintiles was imputed from median neighborhood income. In the study sample of 7,816 patients we determined 1-year mortality by grouped income quintile and used multivariable analyses to assess whether differences in survival were explained by cardiovascular risk factors, stroke severity, stroke management, or other prognostic factors.Results: There was no significant gradient across income groups for stroke severity or stroke management. However, 1-year mortality rates were higher in those from the lowest income group compared to those from the highest income group, even after adjustment for age, sex, stroke type and severity, comorbid conditions, hospital and physician characteristics, and processes of care (adjusted hazard ratio for low-vs high-income groups, 1.18; 95% confidence interval 1.03 to 1.29).Conclusions: In Ontario, 1-year survival rates after an index stroke are higher for those from the richest compared to the least wealthy areas, and this is only partly explained by age, sex, comorbid conditions, and other baseline risk factors. Neurology (R) 2012;79:1200-1207