title: Socioeconomic differences in quality of care and clinical outcome after stroke: a nationwide population-based study.
abstract: OBJECTIVE
  The association among socioeconomic status, quality of care, and clinical outcome after stroke remains poorly understood. In a Danish nationwide follow-up study, we examined whether socioeconomic-related differences in acute stroke care occur and, if so, whether they explain socioeconomic differences in case-fatality and readmission risk.
  
  
  METHODS
  Using population-based public registries, we identified and followed all patients aged≤65 years admitted with stroke from 2003 to 2007 (n=14,545). We compared the proportion of patients receiving 7 specific processes of care according to income, educational attainment, and employment status. Furthermore, we computed 30-day and 1-year hazard ratios for death and readmission adjusted for patient characteristics and received processes of acute stroke care.
  
  
  RESULTS
  For low-income patients and disability pensioners, the relative risk of receiving all of the relevant processes of care was 0.82 (95% CI, 0.78 to 0.86) and 0.83 (95% CI, 0.79 to 0.87), respectively, compared with high-income patients and employed patients. Adjusted 30-day and 1-year hazard ratios for death for unemployed patients were 1.57 (95% CI, 1.25 to 1.97) and 1.58 (1.32 to 1.88), respectively, compared with employed patients. Unemployed patients also had a higher risk of readmission. The differences in mortality and readmission risk remained after controlling for received processes of acute stroke care.
  
  
  CONCLUSIONS
  Low socioeconomic status was associated with a lower chance of receiving optimal acute stroke care. However, the differences in acute care did not appear to explain socioeconomic differences in mortality and readmission risk.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark. vl@dce.au.dk
authors.forename: Vivian
authors.initials: V
authors.lastname: Langagergaard
authors.forename: Kaare H
authors.initials: KH
authors.lastname: Palnum
authors.forename: Frank
authors.initials: F
authors.lastname: Mehnert
authors.forename: Annette
authors.initials: A
authors.lastname: Ingeman
authors.forename: Birgitte R
authors.initials: BR
authors.lastname: Krogh
authors.forename: Paul
authors.initials: P
authors.lastname: Bartels
authors.forename: Søren P
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003718:Denmark; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012923:Social Class; D020521:Stroke / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome