title: Socioeconomic status and care after stroke: results from the Registry of the Canadian Stroke Network.
abstract: OBJECTIVE
  Socioeconomic status is inversely associated with mortality after stroke; however, the reasons behind this finding are not well-understood. We undertook a study to determine whether posthospitalization care and medication adherence vary with neighborhood income.
  
  
  METHODS
  We conducted a cohort study of 11 050 patients with ischemic stroke or transient ischemic attack admitted to any of 11 specialized stroke centers in Ontario, Canada, between July 1, 2003 and March 31, 2008. Socioeconomic status measured as neighborhood income quintiles was imputed from the 2006 Canadian Census. We used linkages to administrative databases to evaluate processes of stroke care and medication adherence within 1 year of discharge. We used multivariable analyses to assess whether differences in stroke care and medication adherence existed across income groups after adjustment for age, sex, stroke severity, and comorbid conditions.
  
  
  RESULTS
  Higher income was associated with higher rates of stroke unit admission, neurology consultations, referrals to secondary prevention clinics, and physician visits after hospital discharge; however, the absolute differences in rates were small. There was no difference across income quintiles in the use of postdischarge homecare services or in adherence to antihypertensive, antithrombotic, or lipid-lowering medications.
  
  
  CONCLUSIONS
  Higher income is associated with improvements in some aspects of stroke care delivery. However, the magnitude of the care gap across income quintiles is small and is unlikely to account for the previously observed association between socioeconomic status and survival after stroke.
authors: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Kun
authors: K
authors: Huang
authors: Nadia
authors: N
authors: Khan
authors: Allison
authors: A
authors: Kwan
authors: Jiming
authors: J
authors: Fang
authors: Lingsong
authors: L
authors: Yun
authors: Moira K
authors: MK
authors: Kapral
mesh_terms: D000359:Aftercare / Q000191:economics* / Q000639:trends; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D019058:Community Networks / Q000191:economics* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010351:Patient Discharge / Q000191:economics* / Q000639:trends; D012042:Registries; D012189:Retrospective Studies; D012923:Social Class; D020521:Stroke / Q000191:economics* / Q000453:epidemiology / Q000628:therapy