Socioeconomic status delays optimal stroke care
MedWire News: Patients with low socioeconomic status are at risk for receiving suboptimal acute stroke care, say researchers.
However, the team found that such differences in acute care did not account for the increased risk for death and readmission seen among patients with low socioeconomic status.
The study was conducted in Denmark, which has a tax-financed universal healthcare system. Despite this, patients of low socioeconomic status were less likely than other patients to receive seven key processes of acute stroke care: early admission to a stroke unit; early administration of antithrombotic therapy; early neuroimaging; and early assessment by a physiotherapist, occupational therapist, and nutritionist.
The nationwide study assessed the care of 14,545 patients, finding that those in the lowest tertile of income were 18% less likely to receive all seven processes of care while in hospital than those in the highest tertile.
There was also a 10% reduction in likelihood of optimal care for patients in the lowest versus highest tertiles of education, and a 17% reduction for disability pensioners versus employed patients.
But Vivian Langagergaard (Aarhus University Hospital) and colleagues note that nearly all patients received certain care processes, such as antithrombotic therapy, at some stage - just not necessarily before hospital discharge.
"Our results therefore indicate later initiation of therapy among low-socioeconomic status patients," they write in the journal Stroke.
Neither low income nor low education affected patients' risk for death or readmission. By contrast, being unemployed was associated with a 57% increase in the risk for death within 30 days and a 58% increase in 1-year mortality risk. Unemployed patients were also 21% more likely than employed patients to be readmitted to hospital within the first year after stroke.
This increased readmission risk "probably reflects a higher vulnerability in this patient group, even after adjustment for differences in prognostic profile," say the researchers.
The team concludes: "Continuous efforts are warranted to ensure optimal stroke care to all patient groups and to explore possible future interventions aimed at reducing the social gradient in stroke outcome."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid