[Correlation between socioeconomic factors and in-hospital mortality from ischemic stroke in a hospital cohort in Colombia, 2003-2006].
OBJECTIVE
To determine if there is a correlation between socioeconomic conditions and in-hospital mortality (IHM) from ischemic stroke in a sample of the Colombian population and identify the chain of events that determine that association.


METHODS
Prospective study of a hospital cohort of patients with ischemic stroke in four Colombian clinical referral institutions-located in Floridablanca, Bucaramanga, Bogotá, and Medellín-between February 2003 and December 2006. Hierarchical analysis was used to group the socioeconomic variables into three levels, and their relationship to IHM due to ischemic stroke was assessed in a Cox proportional hazards model.


RESULTS
The IHM rate was 9.4% in the 253 patients included in the study. In the analysis by levels, mortality was inversely associated with educational level (advanced to primary), monthly income (≥ minimum wage), and participation in the contributory health system. When the three levels were combined in the hierarchical analysis, affiliation with the contributory system was the only association that maintained its statistical significance (RR 0.35; CI 95%: 0.13-0.96; P = 0.04).


CONCLUSIONS
The results indicate that, in Colombia, being affiliated with the contributory health system is an independent protective factor against IHM after an ischemic stroke. The education-income-access to health services sequence is a possible explanation for the relationship between socioeconomic conditions and the clinical outcome of these events. Strategies should be designed to mitigate the differences in the quality and distribution of health services in the Colombian population.
Grupo de Ciencias Neurovasculares, Fundación Cardiovascular de Colombia, Floridablanca, Colombia. federicosilva@fcv.org
Federico Arturo
FA
Silva
Gustavo Adolfo
GA
Díaz
Fredi Alexander
FA
Díaz-Quijano
Mario Alexander
MA
Ardila
María Fernanda
MF
Saavedra
Ronald G
RG
García Gómez
Juan Guillermo
JG
Zarruk
Cristian Federico
CF
Rueda-Clausen
Jorge Alberto
JA
Restrepo Escobar
D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality*; D003105:Colombia; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012959:Socioeconomic Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality*; D013997:Time Factors