Socioeconomic Deprivation and Survival After Stroke Findings From the Prospective South London Stroke Register of 1995 to 2011
Socioeconomic Deprivation and Survival After Stroke Findings From the Prospective South London Stroke Register of 1995 to 2011
复制标题
DOI：
10.1161/strokeaha.113.003266
复制
发表时间：
2014-01-01
期刊：
影响因子：
8.3
通讯作者：
Wolfe, Charles D. A.
中科院分区：
文献类型：
--
作者：
Chen, Ruoling;McKevitt, Christopher;Wolfe, Charles D. A.
背景和目的：以往关于社会经济剥夺（SED）与卒中后生存率之间关系的研究结果并不一致。对长期生存的研究较少。我们评估了协会在多民族人口在England.Methods我们检查了4398例患者（3103名白人，932名黑人，253名亚洲人/其他）首次中风，收集的人口为基础的中风登记在南伦敦从1995年至2011年的数据。SED采用卡斯泰尔斯指数评分进行测量，评分越高，剥夺越严重。多因素考克斯回归模型分析，在17年的随访中，2754例患者死亡。卡斯泰尔斯评分的四分位数数据显示，除加勒比黑人和非洲人外，SED与患者生存率无显著相关性。第四个四分位数SED的黑人患者3个月死亡率的多变量校正风险比为1.76（95%置信区间，1.06-2.94），1年死亡率的多变量校正风险比为1.54（1.00-2.37）。在调整急性卒中护理规定后，这些不再重要。然而，卡斯泰尔斯评分的六分位数据显示SED与卒中后生存率一致相关;第六个六分位数的所有患者3个月死亡率和17年死亡率的完全校正危险比分别为1.23（1.05-1.44）和1.13（1.01-1.25）。结论在英国，SED与卒中后生存率降低之间存在微弱但显著的相关性。与白色患者相比，黑人SED对短期生存率的影响可能更大。需要进一步努力实现不同社会经济群体中风患者的生存平等。
Background and Purpose Previous findings of the association between socioeconomic deprivation (SED) and survival after stroke are inconsistent. There is less investigation on long-term survival. We assessed the associations in a multi-ethnic population in England.Methods We examined data from 4398 patients (3103 whites, 932 blacks, and 253 Asians/others) with first-ever stroke, collected by a population-based stroke register in South London from 1995 to 2011. SED was measured using the Carstairs index scorethe higher score, the more deprived. It was analyzed in multivariate Cox regression models in relation to survival after stroke.Results During 17-year follow-up 2754 patients died. The quartile data of Carstairs score showed no significant association of SED with survival in patients, except for black Caribbeans and Africans. Black patients with the fourth quartile SED had a multivariate adjusted hazard ratio of 1.76 (95% confidence interval, 1.06-2.94) for 3-month mortality and 1.54 (1.00-2.37) for 1-year mortality. After adjustment for acute stroke care provisions, these were no longer significant. However, the sextile data of Carstairs score showed a consistent association of SED with survival after stroke; all patients with the sixth sextile had a fully adjusted hazard ratio of 1.23 (1.05-1.44) for 3-month mortality and 1.13 (1.01-1.25) for 17-year mortality.Conclusions There is a weak but significant association of SED with reduced survival after stroke in England. SED in blacks may have a stronger impact on short-term survival when compared with white patients. Further efforts are required to achieve equality in survival among patients with stroke of different socioeconomic groups.