title: Socioeconomic deprivation and survival after stroke: findings from the prospective South London Stroke Register of 1995 to 2011.
abstract: OBJECTIVE
  Previous findings of the association between socioeconomic deprivation (SED) and survival after stroke are inconsistent. There is less investigation on long-term survival. We assessed the associations in a multi-ethnic population in England.
  
  
  METHODS
  We examined data from 4398 patients (3103 whites, 932 blacks, and 253 Asians/others) with first-ever stroke, collected by a population-based stroke register in South London from 1995 to 2011. SED was measured using the Carstairs index score-the higher score, the more deprived. It was analyzed in multivariate Cox regression models in relation to survival after stroke.
  
  
  RESULTS
  During 17-year follow-up 2754 patients died. The quartile data of Carstairs score showed no significant association of SED with survival in patients, except for black Caribbeans and Africans. Black patients with the fourth quartile SED had a multivariate adjusted hazard ratio of 1.76 (95% confidence interval, 1.06-2.94) for 3-month mortality and 1.54 (1.00-2.37) for 1-year mortality. After adjustment for acute stroke care provisions, these were no longer significant. However, the sextile data of Carstairs score showed a consistent association of SED with survival after stroke; all patients with the sixth sextile had a fully adjusted hazard ratio of 1.23 (1.05-1.44) for 3-month mortality and 1.13 (1.01-1.25) for 17-year mortality.
  
  
  CONCLUSIONS
  There is a weak but significant association of SED with reduced survival after stroke in England. SED in blacks may have a stronger impact on short-term survival when compared with white patients. Further efforts are required to achieve equality in survival among patients with stroke of different socioeconomic groups.
authors.affiliation: From the Division of Health and Social Care Research, King's College London, London, United Kingdom (R.C., C.M., A.G.R., C.D.A.W.); and National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service (NHS) Foundation Trust and King's College London, United Kingdom (A.G.R., C.D.A.W.).
authors.forename: Ruoling
authors.initials: R
authors.lastname: Chen
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Rudd
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology; D011203:Poverty / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013064:Speech Disorders / Q000209:etiology; D020521:Stroke / Q000150:complications / Q000191:economics / Q000401:mortality*; D013534:Survival; D017741:Survivors / Q000706:statistics & numerical data*
keywords: cohort studies; ethnicity; long-term care; stroke, survival; subacute care