Disparities in stroke preventive care in general practice did not explain socioeconomic disparities in stroke.
OBJECTIVE
To assess socioeconomic disparities in stroke incidence and in the quality of preventive care for stroke in the Netherlands.


METHODS
A total of 190,664 patients who registered in 96 general practices were followed up for 12 months. Data were collected on diagnoses, referrals, prescriptions, and diagnostic procedures. Hazard ratios (HR) were calculated to assess the association between educational level and stroke incidence. Multilevel logistic regression was used to assess socioeconomic disparities in the quality of preventive care for stroke precursors.


RESULTS
Lower educational level was associated with higher incidence of stroke in men (HR=1.36, 95% CI=1.06-1.74) but not in women. Among both men and women, there were socioeconomic disparities in the prevalence of hypertension, hypercholesterolemia, diabetes, angina pectoris, heart failure, and peripheral artery disease. Lower educated hypercholesterolemia patients under medication were less likely to be prescribed statins (odds ratio=0.62, 95% CI=0.42-0.91). However, for other precursors of stroke, there were no major disparities in the quality of preventive care.


CONCLUSIONS
There are socioeconomic disparities in stroke incidence among men but not among women. Socioeconomic differences in factors such as hypertension and diabetes are likely to contribute to stroke disparities. However, general practitioners (GPs) provide care of a similar quality to patients from different socioeconomic groups.
Avendano
M
M
Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. m.avendanopabon@erasmusmc.nl
Boshuizen
H C
HC
Schellevis
F G
FG
Mackenbach
J P
JP
Van Lenthe
F J
FJ
Van den Bos
G A M
GA
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology; D004232:Diuretics / Q000627:therapeutic use; D004522:Educational Status; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011787:Quality of Health Care / Q000592:standards*; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors