Effect of deprivation and gender on the incidence and management of acute brain disorders.
OBJECTIVE
To determine the impact of deprivation and gender on the incidence and emergency management of acute brain disorders.


METHODS
Retrospective database review of mortality, hospital discharge, and ICU discharge data.


METHODS
Lothian Health Board area, 1995-1999.


METHODS
All persons over the age of 15 dying or being discharged from hospital with a primary diagnosis of stroke, epilepsy, subarachnoid haemorrhage (SAH) or traumatic brain injury; patients registered in the Scottish Intensive Care Society Audit Database as having been discharged from the supraregional neurosciences intensive care unit with one of these as a primary diagnoses and a home postcode within the Lothian Health Board area.


RESULTS
Standardised ratios were calculated for hospital admission, mortality, and ICU admission by deprivation category and gender. Data were available for 29,205 hospital admissions, 5,227 deaths, and 360 ICU admissions. For all diagnoses, deprivation was associated with higher rates of hospital admission and death. Deprivation was associated with lower rates of ICU admission for traumatic brain injury and stroke. There was a U-shaped relationship between deprivation and ICU admission with epilepsy. There were no gender differences in rates of ICU admission. Males had higher rates of hospital admission for all conditions and of death from epilepsy and SAH, and lower rates of death from stroke.


CONCLUSIONS
We have demonstrated deprivation- and gender- differences in the incidence and emergency management of four acute brain disorders. The identification of the source(s) of these differences is an important subject for further research.
Macleod
M R
MR
Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, EH2 4XU, UK. malcolm@apoptosis.freeserve.co.uk
Andrews
P J D
PJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000628:therapy*; D004827:Epilepsy / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011203:Poverty; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000628:therapy*