title: Education level and inequalities in stroke reperfusion therapy: observations in the Swedish stroke register.
abstract: OBJECTIVE
  Previous studies have revealed inequalities in stroke treatment based on demographics, hospital type, and region. We used the Swedish Stroke Register (Riksstroke) to test whether patient education level is associated with reperfusion (either or both of thrombolysis and thrombectomy) treatment.
  
  
  METHODS
  We included 85 885 patients with ischemic stroke aged 18 to 80 years registered in Riksstroke between 2003 and 2009. Education level was retrieved from Statistics Sweden, and thrombolysis, thrombectomy, patient, and hospital data were obtained from Riksstroke. We used multivariable logistic regression to analyze the association between reperfusion therapy and patient education.
  
  
  RESULTS
  A total of 3649 (4.2%) of the patients received reperfusion therapy. University-educated patients were more likely to be treated (5.5%) than patients with secondary (4.6%) or primary education (3.6%; P<0.001). The inequality associated with education was still present after adjustment for patient characteristics; university education odds ratio, 1.14; 95% confidence interval, 1.03 to 1.26 and secondary education odds ratio, 1.08; 95% confidence interval, 1.00 to 1.17 compared with primary education. Higher hospital specialization level was also associated with higher reperfusion levels (P<0.001). In stratified multivariable analyses by hospital type, significant treatment differences by education level existed only among large nonuniversity hospitals (university education odds ratio, 1.20; 95% confidence interval, 1.04-1.40; secondary education odds ratio, 1.14; 95% confidence interval, 1.01-1.29).
  
  
  CONCLUSIONS
  We demonstrated a social stratification in reperfusion, partly explained by patient characteristics and the local hospital specialization level. Further studies should address treatment delays, stroke knowledge, and means to improve reperfusion implementation in less specialized hospitals.
authors: From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.). anna.stecksen@medicin.umu.se.
authors: Anna
authors: A
authors: Stecksén
authors: From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.).
authors: Eva-Lotta
authors: EL
authors: Glader
authors: From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.).
authors: Kjell
authors: K
authors: Asplund
authors: From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.).
authors: Bo
authors: B
authors: Norrving
authors: From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.).
authors: Marie
authors: M
authors: Eriksson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D015424:Reperfusion / Q000379:methods*; D020521:Stroke / Q000628:therapy*; D013548:Sweden; D015912:Thrombolytic Therapy / Q000379:methods*; D055815:Young Adult
keywords: education; reperfusion; thrombectomy; thrombolytic therapy