ArticleBMC public health2016
Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study.
Article in BMC public health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Is the socioeconomic inequality in stroke prognosis changing over time and does quality of care play a role?European stroke journal · 2023Article
- Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation.Annals of medicine · 2022Article
- From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke.Frontiers in neurology · 2021Review
- Socioeconomic status predicts the risk of stroke death: A systematic review and meta-analysis.Preventive medicine reports · 2020Review
- High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy.PloS one · 2019Article
- Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil.International journal for equity in health · 2017Article
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThe reasons for socioeconomic inequity in stroke mortality are not well understood. The aim of this study was to explore the role of ischemic stroke care-pathways on the association between education level and one-year survival after hospital admission.
methodsHospitalizations for ischemic stroke during 2011/12 were selected from Lazio health data. Patients' clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. The association between education level and mortality after stroke was studied for acute and post-acute phases using multilevel logistic models (Odds Ratio (OR)). Different scenarios of quality care-pathways were identified considering hospital performance, access to rehabilitation and drug treatment post-discharge. The probability to survive to acute and post-acute phases according to education level and care-pathway scenarios was estimated for a "mean-severity" patient. One-year survival probability was calculated as the product of two probabilities. For each scenario, the 1-year survival probability ratio, university versus elementary education, and its Bootstrap Confidence Intervals (95 % BCI) were calculated.
resultsWe identified 9,958 patients with ischemic stroke, 53.3 % with elementary education level and 3.2 % with university. The mortality was 14.9 % in acute phase and 14.3 % in post-acute phase among survived to the acute phase. The adjusted mortality in acute and post-acute phases decreased with an increase in educational level (OR = 0.90 p-trend < 0.001; OR = 0.85 p-trend < 0.001). For the best care-pathway, the one-year survival probability ratio was 1.06 (95 % BCI = 1.03-1.10), while it was 1.17 (95 % BCI = 1.09-1.25) for the worst.
conclusionsEducation level was inversely associated with mortality both in acute and post-acute phases. The care-pathway reduces but does not eliminate 1-year survival inequity.
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