title: Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland.
abstract: BACKGROUND
  Socioeconomic status is thought to have a significant influence on stroke incidence, risk factors and outcome. Its influence on acute stroke severity, stroke mechanisms, and acute recanalisation treatment is less known.
  
  
  METHODS
  Over a 4-year period, all ischaemic stroke patients admitted within 24h were entered prospectively in a stroke registry. Data included insurance status, demographics, risk factors, time to hospital arrival, initial stroke severity (NIHSS), etiology, use of acute treatments, short-term outcome (modified Rankin Scale, mRS). Private insured patients (PI) were compared with basic insured patients (BI).
  
  
  RESULTS
  Of 1062 consecutive acute ischaemic stroke patients, 203 had PI and 859 had BI. They were 585 men and 477 women. Both populations were similar in age, cardiovascular risk factors and preventive medications. The onset to admission time, thrombolysis rate, and stroke etiology according to TOAST classification were not different between PI and BI. Mean NIHSS at admission was significantly higher for BI. Good outcome (mRS≤2) at 7days and 3months was more frequent in PI than in BI.
  
  
  CONCLUSIONS
  We found better outcome and lesser stroke severity on admission in patients with higher socioeconomic status in an acute stroke population. The reason for milder strokes in patients with better socioeconomic status in a universal health care system needs to be explained.
authors.affiliation: Clinical Neurosciences Department, Neurology Service Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. Vincianne.rey@chuv.ch
authors.forename: V
authors.initials: V
authors.lastname: Rey
authors.forename: M
authors.initials: M
authors.lastname: Faouzi
authors.forename: M
authors.initials: M
authors.lastname: Huchmand-Zadeh
authors.forename: P
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006269:Health Facilities, Proprietary / Q000191:economics* / Q000639:trends; D006297:Health Services Accessibility / Q000639:trends; D054625:Healthcare Disparities / Q000191:economics* / Q000639:trends; D016304:Hospitals, Private / Q000191:economics / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000639:trends*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000191:economics* / Q000401:mortality; D000071939:Stroke Rehabilitation; D013557:Switzerland / Q000453:epidemiology