title: Mortality following stroke during and after acute care according to neighbourhood deprivation: a disease registry study.
abstract: BACKGROUND
  Neighbourhood deprivation has been shown to be inversely associated with mortality 1 month after stroke. Whether this disadvantage begins while patients are still receiving acute care is unclear. We aimed to study mortality after stroke specifically in the period while patients are under acute care and the ensuing period when they are discharged to home or other care settings.
  
  
  METHODS
  Our sample includes 1760 incident strokes (mean age 75, 48% men, 86% ischaemic) identified between 1998 and 2010 by the population-based stroke registry of Dijon (France). We used Cox regression to study all-cause mortality up to 90 days after stroke occurrence.
  
  
  RESULTS
  Overall, 284 (16.1%) patients died during the 90 days following stroke. Prior to stroke, risk factors prevalence (eg, high blood pressure and diabetes) and acute care management did not vary across deprivation levels. There was no association between deprivation and mortality while patients were in acute care (HR comparing the highest to the lowest tertiles of deprivation: 1.01, 95% CI 0.71 to 1.43). After discharge, however, age and gender adjusted mortality gradually increased with deprivation (HR 2.08, 95% CI 1.07 to 4.02). This association was not modified when stroke type and severity were accounted for.
  
  
  CONCLUSIONS
  The gradient of higher poststroke mortality with increasing neighbourhood deprivation was noticeable only after acute hospital discharge. Quality of postacute care and social support are potential determinants of these variations.
authors.affiliation: French School of Public Health (EHESP), Rennes, France INSERM U707, Research Group on the Social Determinants of Health and Healthcare, UPMC, Univ Paris 6, Paris, France.
authors.forename: Olivier
authors.identifier: http://orcid.org/0000-0003-1087-9197
authors.initials: O
authors.lastname: Grimaud
authors.affiliation: French School of Public Health (EHESP), Rennes, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Leray
authors.affiliation: French School of Public Health (EHESP), Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lalloué
authors.affiliation: French School of Public Health (EHESP), Rennes, France.
authors.forename: Radouane
authors.initials: R
authors.lastname: Aghzaf
authors.affiliation: Department of Neurology, Dijon Stroke Registry, EA 4184, University Hospital and Medical School of Dijon, Dijon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Durier
authors.affiliation: Department of Neurology, Dijon Stroke Registry, EA 4184, University Hospital and Medical School of Dijon, Dijon, France.
authors.forename: Maurice
authors.initials: M
authors.lastname: Giroud
authors.affiliation: Department of Neurology, Dijon Stroke Registry, EA 4184, University Hospital and Medical School of Dijon, Dijon, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Béjot
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D011204:Poverty Areas; D016016:Proportional Hazards Models; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality* / Q000628:therapy