Socioeconomic variations in the course of stroke: unequal health outcomes, equal care?
OBJECTIVE
The aim of this paper is to quantify the socioeconomic gap in long term health outcomes after stroke and related health care utilisation, in order to evaluate whether those in need of care do actually receive appropriate levels of care.


METHODS
Stroke patients from the lower socioeconomic group were compared with stroke patients from the higher socioeconomic group with respect to sociodemographic and clinical characteristics, health outcomes, and related health care utilisation.


METHODS
Patients were recruited from admissions to 23 randomly selected hospitals in the Netherlands.


METHODS
465 patients were included who had had a stroke six months earlier and were followed up three years and five years after stroke.


RESULTS
The observed odds ratios suggest that patients from the lower socioeconomic group experienced more disabilities up to three years after stroke and more handicaps up to five years after stroke. After adjusting for health care needs there were no significant associations between socioeconomic status and health care utilisation. The observed figures, however, suggest that a lower socioeconomic status tended to increase admission to nursing homes and to decrease receiving care in non-institutional settings.


CONCLUSIONS
Overall, inequalities in long term health outcomes were observed but solid indications for large inequalities in health care utilisation were not found. More investments in coordinated stroke services are needed to alleviate the unfavourable health situation of disadvantaged groups and to ensure that health care services respond appropriately to the health care needs of different socioeconomic groups.
van den Bos
G A M
GA
National Institute of Public Health and the Environment, Department for Health Services Research and Academic Medical Centre, Netherlands. GAM.van.den.Bos@rivm.nl
Smits
J P J M
JP
Westert
G P
GP
van Straten
A
A
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000706:statistics & numerical data; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D020127:Recovery of Function; D012923:Social Class; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics; D000071939:Stroke Rehabilitation; D035862:Vulnerable Populations