Effect of area-based deprivation on the severity, subtype, and outcome of ischemic stroke.
OBJECTIVE
Markers of low socioeconomic status (deprivation) are associated with stroke and its causes. In the United Kingdom, area-based deprivation measures are available routinely through links with postal codes. We hypothesized that deprivation is associated with ischemic stroke risk factors, severity, subtype, and outcome.


METHODS
We studied 2026 patients, each with at least 2 years of outcome follow-up by record linkage after first admission with ischemic stroke to an acute stroke unit. Baseline factors recorded routinely were age, sex, medical history, blood pressure, and stroke severity and subtype. Deprivation was assessed by the Womersley score (WS) and Murray score (MS).


RESULTS
Higher WS and MS were associated with stroke at younger age (eg, WS linear regression coefficient (r)=-0.26; 95% confidence interval [CI], -0.51 to -0.01 per additional point), smoking (odds ratio [OR], 1.12; 95% CI, 1.08 to 1.17), and claudication (OR, 1.09; 95% CI, 1.01 to 1.17); WS was associated with higher systolic blood pressure (r=0.13; 95% CI, 0.02 to 0.24); and MS was associated with severe stroke. Deprivation was not associated with case fatality in univariate analysis or after correction for all baseline factors. Deprivation was associated with readmission to hospital as a result of any vascular event in univariate analysis (hazard ratio [HR], 1.05; 95% CI, 1.02 to 1.09) and after correction for all baseline factors (HR, 1.06; 95% CI, 1.02 to 1.10).


CONCLUSIONS
Tackling health inequalities in stroke should focus on stroke primary prevention by tackling deprivation, including promoting changes in lifestyle.
Division of Cardiovascular and Medical Sciences, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, UK. 0110768a@student.gla.ac.uk
Stella
S
Aslanyan
Christopher J
CJ
Weir
Kennedy R
KR
Lees
John L
JL
Reid
Gordon T
GT
McInnes
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008019:Life Style; D016014:Linear Models; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011204:Poverty Areas; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D012923:Social Class; D020521:Stroke / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology