Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System
Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System
复制标题
DOI：
10.1161/strokeaha.108.542944
复制
发表时间：
2009-08-01
期刊：
影响因子：
8.3
通讯作者：
Perucci, Carlo Alberto
中科院分区：
文献类型：
--
作者：
Cesaroni, Giulia;Agabiti, Nera;Perucci, Carlo Alberto
背景与目的：低社会经济地位（SEP）与卒中总死亡率高相关，但其对卒中预后的影响尚不清楚。我们评估了脑卒中发病率和脑卒中后结局的社会经济差异。方法：我们收集了2001年至2004年间首次急性缺血性或出血性中风的35至84岁罗马居民的出院和死亡率数据。我们使用小面积SEP指数。我们使用泊松回归计算致命性和非致命性脑卒中亚型的年龄校正发病率和SEP比率。采用Logistic回归研究SEP的结果（30天死亡率、1个月幸存者：1年死亡率、连续卒中再入院率和心血管疾病）。结果：共观察到10 033例卒中，其中缺血性卒中占75%。缺血性中风和出血性中风的发病率（每10万人）分别为：男性104和34，女性81和28。两性卒中发病率存在社会经济差异（缺血性卒中和出血性卒中极端SEP类别之间的比率：1.76;95% CI, 1.59 ~ 1.95；男性1.50;95% CI, 1.26 ~ 1.80；女性1.72;95% CI, 1.55 ~ 1.91；女性1.37;95% CI, 1.15 ~ 1.63）。未发现SEP与卒中后死亡率相关。低SEP伴缺血性卒中的男性比高SEP的男性更容易因新发卒中住院，低SEP伴出血性卒中的女性比高SEP的女性更容易因心血管疾病住院。结论-卒中发病率在不同社会经济群体之间存在显著差异，反映了生活方式和临床危险因素的异质性分布。初级预防战略应针对较不富裕的人群。（中风。2009;40:2812-2819）
Background and Purpose-Low socioeconomic position (SEP) is associated with high overall stroke mortality, but its contribution to stroke prognosis is unclear. We evaluated socioeconomic disparities in stroke incidence and poststroke outcomes.Methods-We collected hospital discharge and mortality data for all 35- to 84-year-old Rome residents who had a first acute ischemic or hemorrhagic stroke in 2001 to 2004. We used a small-area SEP index. We calculated age-adjusted incidence rates and rate ratios by SEP for fatal and nonfatal stroke subtypes using Poisson regression. Logistic regression was used to study outcomes by SEP (30-day mortality, and among 1-month survivors: 1-year mortality, hospital readmissions for a successive stroke, and cardiovascular diseases).Results-A total of 10 033 incident strokes (75% ischemic) were observed. Incidence rates (per 100 000) for ischemic and hemorrhagic stroke were: 104 and 34 in men and 81 and 28 in women, respectively. There were socioeconomic disparities in stroke incidence in both genders (rate ratios between extreme SEP categories in ischemic and hemorrhagic stroke: 1.76; 95% CI, 1.59 to 1.95; 1.50; 95% CI, 1.26 to 1.80 in men; 1.72; 95% CI, 1.55 to 1.91; 1.37; 95% CI, 1.15 to 1.63 in women). No association was found for SEP and mortality after stroke. Men with low SEP with an ischemic event were more likely to be hospitalized for a new stroke than men with high SEP. Women with low SEP with hemorrhagic stroke were more likely to be hospitalized for cardiovascular disease compared with women with high SEP.Conclusions-Stroke incidence strongly differs between socioeconomic groups reflecting a heterogeneous distribution of lifestyle and clinical risk factors. Strategies for primary prevention should target less affluent people. (Stroke. 2009; 40: 2812-2819.)