ArticleBMJ (Clinical research ed.)2009
Sociodemographic variations in the contribution of secondary drug prevention to stroke survival at middle and older ages: cohort study.
Article in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Interventions for improving modifiable risk factor control in the secondary prevention of stroke.The Cochrane database of systematic reviews · 2018Pooled it
- Identifying inequitable healthcare in older people: systematic review of current research practice.International journal for equity in health · 2017Pooled it
- Trends in the Use of Medications for Secondary Ischemic Stroke Prevention in Denmark, 2005-2021.Neurology · 2024Article
- Coverage and equity of essential care services among stroke survivors in the Western Province of Sri Lanka: a community-based cross-sectional study.BMC health services research · 2022Article
- Statin use and high-dose statin use after ischemic stroke in the UK: a retrospective cohort study.Clinical epidemiology · 2019Article
- Stroke in Older Survivors of Ischemic Stroke: Standard Care or Something Different?Geriatrics (Basel, Switzerland) · 2017Article
- Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review.Neuro-ophthalmology (Aeolus Press) · 2017Review
- Age-related references in national public health, technology appraisal and clinical guidelines and guidance: documentary analysis.Age and ageing · 2017Article
- Observational
- Age disparity in diagnostic evaluation of stroke patients: Embolic Stroke of Undetermined Source Global Registry Project.European stroke journal · 2016Article
- Older people's priorities in health and social care research and practice: a public engagement workshop.Research involvement and engagement · 2016Article
- Medicines taken by older Australians after transient ischaemic attack or ischaemic stroke: a retrospective database study.International journal of clinical pharmacy · 2015Article
- Risk awareness in secondary stroke prevention: a review of the literature.JRSM cardiovascular disease · 2014Article
- Why is controlling blood pressure after stroke so difficult?CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2013Article
- Comparison of provision of stroke care in younger and older patients: findings from the South london stroke register.Stroke research and treatment · 2012Article
- Effect of socioeconomic status on secondary prevention of stroke.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2011Article
- Explaining variation in referral from primary to secondary care: cohort study.BMJ (Clinical research ed.) · 2010Article
- Declining 1-year case-fatality of stroke and increasing coverage of vascular risk management: population-based cohort study.Journal of neurology, neurosurgery, and psychiatry · 2010Article
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesTo determine the extent to which secondary drug prevention for patients with stroke in routine primary care varies by sex, age, and socioeconomic circumstances, and to quantify the effect of secondary drug prevention on one year mortality by sociodemographic group.
designCohort study using individual patient data from the health improvement network primary care database.
settingEngland.
participants12 830 patients aged 50 or more years from 113 general practices who had a stroke between 1995 and 2005 and who survived the first 30 days after the stroke.
main outcome measuresMultivariable associations between odds of receiving secondary prevention after a stroke, and sex, age group, and socioeconomic circumstances; hazard ratios for all cause mortality from 31 days after the stroke and within the first year among patients receiving treatment and by social group; and probabilities of one year mortality for social factors of interest and treatment.
resultsOnly 25.6% of men and 20.8% of women received secondary prevention. Receipt of secondary prevention did not vary by socioeconomic circumstances or by sex. Older patients were, however, substantially less likely to receive treatment. The adjusted odds ratio for 80-89 year olds compared with 50-59 year olds was 0.53 (95% confidence interval 0.41 to 0.69). This was because older people were less likely to receive lipid lowering drugs-for example, the adjusted odds ratio for 80-89 year olds compared with 50-59 year olds was 0.44 (95% confidence interval 0.33 to 0.59). Secondary prevention was associated with a 50% reduction in mortality risk (adjusted hazard ratio 0.50, 95% confidence interval 0.42 to 59). On average, mortality within the first year was 5.7% for patients receiving treatment compared with 11.1% for patients not receiving treatment. There was little evidence that the effect of treatment differed between the social groups examined.
conclusionUnder-treatment among older people with stroke in routine primary care cannot be justified given the lack of evidence on variations in effectiveness of treatment by age.
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