Are there inequalities in the provision of stroke care? Analysis of an inner-city stroke register.
OBJECTIVE
There is evidence of unequal access to health care interventions even where universal health systems operate. We investigated associations between patients' sociodemographic characteristics and the provision of acute and longer-term stroke care in a multiethnic urban population.


METHODS
We used data from 1635 patients with first-ever stroke, collected by a population-based stroke register from 1995 to 2000. Using multivariable analyses, controlled for sociodemographic and clinical factors, we investigated access to 22 evidence-based components of care.


RESULTS
1392 patients (85.1%) were admitted to hospital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with clinical need, 607 (70.7%) received physical therapies; 477 (59.8%) received speech and language therapy. Older age was associated with lower odds of hospitalization (odds ratio [OR], 0.50; 95% CI, 0.32 to 0.77, P=0.02) and diagnostic brain imaging (OR, 0.15; 95% CI, 0.08 to 0.30, P<0.01) but higher odds of receiving physical therapy (OR, 4.24; 95% CI, 1.22 to 14.73, P<0.01). Black ethnicity was associated with higher odds of stroke unit admission (OR, 1.59; 95% CI, 1.01 to 2.49, P<0.04). There was a weak association between socioeconomic status and admission to hospital and stroke unit. Gender was associated only with treatment of hypertension before stroke.


CONCLUSIONS
Provision of individual components of care over 1 year varied for specific sociodemographic categories, but there was no consistent pattern of inequality. Clinical decision-making processes are likely to influence these patterns. Further information about clinician and patient roles in decision making is required.
McKevitt
Christopher
C
Department of Public Health Sciences, King's College London, Capital House, 42 Weston Street, London SE1 3QD, United Kingdom. christopher.mckevitt@kcl.ac.uk
Coshall
Catherine
C
Tilling
Kate
K
Wolfe
Charles
C
D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003710:Demography; D005260:Female; D015600:Glasgow Coma Scale; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D026761:Physical Therapy Specialty / Q000191:economics; D012042:Registries; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics* / Q000628:therapy*; D013997:Time Factors; D014504:Urban Health; D019037:Urban Health Services / Q000191:economics / Q000706:statistics & numerical data; D014505:Urban Population