The influence of individual socioeconomic status on the clinical outcomes in ischemic stroke patients with different neighborhood status in Shanghai, China.
The influence of individual socioeconomic status on the clinical outcomes in ischemic stroke patients with different neighborhood status in Shanghai, China.
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上海地区不同社区状况缺血性脑卒中患者个体社会经济状况对临床结局的影响
DOI：
10.7150/ijms.17241
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发表时间：
2017
影响因子：
3.6
通讯作者：
Liu X
中科院分区：
文献类型：
--
作者：
Yan H;Liu B;Meng G;Shang B;Jie Q;Wei Y;Liu X
目标：社会经济地位（SES）被认为是社会和医疗问题的一个重要因素。本研究的目的是探讨 SES 与缺血性卒中之间的关系，并探讨 SES 是否是中国上海不同社区状况患者临床结果的预测因子。方法：本回顾性研究共纳入 471 名年龄 18-80 岁的首次缺血性脑卒中患者。每位患者的个人社会经济地位通过其教育水平、家庭收入、职业和医疗报销率得出的总分进行评估。分析临床不良事件和全因死亡率以确定 SES 是否是一个预后因素，然后在调整其他协变量后，使用多变量 Cox 比例风险模型根据不同的社区状态评估其预后影响。结果：个人社会经济地位与邻里地位呈显着正相关（r = 0.370；P < 0.001）。低SES患者的临床不良事件发生率和死亡率显着高于中、高SES患者（分别P = 0.001和P = 0.037）。调整其他危险因素和社区状况后，Kaplan-Meier 分析显示低 SES 患者的临床不良事件和死亡人数仍然较高（均 P < 0.05）。多变量Cox回归分析表明，个人SES和邻里状况都是缺血性脑卒中的独立预后因素（均P < 0.05）。此外，在中低社区地位的患者中，较低的个体SES与临床不良事件和死亡率显着相关（均P < 0.05）。结论：个体SES和邻里状态均与缺血性卒中后的预后显着相关。个人社会经济地位较低以及社区状况较差可能会显着增加缺血性中风患者出现不良临床结果的风险。
Objective: Socioeconomic status (SES) is being recognized as an important factor in both social and medical problems. The aim of present study is to examine the relationship between SES and ischemic stroke and investigate whether SES is a predictor of clinical outcomes among patients with different neighborhood status from Shanghai, China. Methods: A total of 471 first-ever ischemic stroke patients aged 18-80 years were enrolled in this retrospective study. The personal SES of each patient was evaluated using a summed score derived from his or her educational level, household income, occupation, and medical reimbursement rate. Clinical adverse events and all-cause mortality were analyzed to determine whether SES was a prognostic factor, its prognostic impact was then assessed based on different neighborhood status using multivariable Cox proportional hazard models after adjusting for other covariates. Results: The individual SES showed a significant positive correlation with neighborhood status (r = 0.370; P < 0.001). The incidence of clinical adverse events and mortality were significantly higher in low SES patients compared with middle and high SES patients (P = 0.001 and P = 0.037, respectively). After adjusting other risk factors and neighborhood status, Kaplan-Meier analysis showed clinical adverse events and deaths were still higher in the low SES patients (all P < 0.05). Multivariate Cox regression analysis demonstrated that both personal SES and neighborhood status are independent prognostic factors for ischemic stroke (all P < 0.05). Besides, among patients with low and middle neighborhood status, lower individual SES was significantly associated with clinical adverse events and mortality (all P < 0.05). Conclusion: Both individual SES and neighborhood status are significantly associated with the prognosis after ischemic stroke. A lower personal SES as well as poorer neighborhood status may significantly increase risk for adverse clinical outcomes among ischemic stroke patients.