title: Unemployment: a social risk factor associated with early ischemic stroke mortality? Results from the Argentinean National Stroke Registry (ReNACer).
abstract: Employment is an indicator of socioeconomic status. Unemployment is a worldwide social challenge, especially in emerging countries, accounting for a proportion of the overall higher mortality rates found in these nations. We assessed the relationship between employment status and in-hospital mortality among acute ischemic stroke patients participating in the Argentinean National Stroke Registry (ReNACer), a prospective, country-wide, hospital-based stroke registry aimed at improving quality of stroke care in Argentina. We compared demographic and socioeconomic characteristics, risk factors, acute treatment, and stroke severity between employed and unemployed patients with acute ischemic stroke participating in ReNACer. We developed a multiple logistic regression model to identify predictors of in-hospital mortality. Among the 726 patients with acute ischemic stroke included in the study, 39.5% were unemployed. In-hospital mortality was higher in the patients who were unemployed at the time of the stroke compared with those who were employed (12.0% v 5.0%; P = .003). On multivariate analysis, being unemployed (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.36-7.37; P = .005), stroke severity (OR, 3.54; 95% CI 1.11-10.40; P = .018), and infarct size >15 mm (OR, 2.80; 95% CI, 1.18-6.60; P = .019) were associated with in-hospital mortality after adjusting for relevant covariates. Social factors may influence poor outcomes after stroke. In the present study, unemployment was associated with a higher risk of adjusted in-hospital mortality. Strategies targeting individuals at high risk of cardiovascular diseases and poorer outcomes should be implemented to reduce stroke impact.
authors.affiliation: Neurovascular Clinic, INECO, Vascular Research Unit, INECO Foundation, and Stroke Center, Institute of Neurosciences, University Hospital, Favaloro Foundation, Buenos Aires, Argentina. lsposato@ineco.org.ar
authors.forename: Luciano A
authors.initials: LA
authors.lastname: Sposato
authors.forename: Pablo
authors.initials: P
authors.lastname: Ioli
authors.forename: Guillermo
authors.initials: G
authors.lastname: Povedano
authors.forename: María Martha
authors.initials: MM
authors.lastname: Esnaola y Rojas
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
mesh_terms: D001118:Argentina / Q000453:epidemiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*; D013997:Time Factors; D014478:Unemployment