title: Stroke outcomes in a socio-economically disadvantaged urban community.
abstract: OBJECTIVE
  To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources.
  
  
  METHODS
  Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded.
  
  
  RESULTS
  The study included 196 patients. Median age was 60 (IQR 51-69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3-12) and median mRS 4 (IQR 3-5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79-0.96, p < 0.0001) and disability (mRS OR 2.34, 95%CI 1.20-4.54, p < 0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95% CI 1.22-9.59, p = 0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months.
  
  
  CONCLUSIONS
  Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes.
authors.affiliation: Division of Geriatric Medicine, Groote Schuur Hospital and University of Cape Town. linda.devilliers@uct.ac.za
authors.forename: Linda
authors.initials: L
authors.lastname: de Villiers
authors.forename: Motasim
authors.initials: M
authors.lastname: Badri
authors.forename: Monica
authors.initials: M
authors.lastname: Ferreira
authors.forename: Alan
authors.initials: A
authors.lastname: Bryer
mesh_terms: D000368:Aged; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D020521:Stroke / Q000191:economics / Q000453:epidemiology*; D000071939:Stroke Rehabilitation; D015996:Survival Rate / Q000639:trends; D035862:Vulnerable Populations / Q000706:statistics & numerical data*