title: Socioeconomic deprivation and survival after stroke in China: a systematic literature review and a new population-based cohort study.
abstract: OBJECTIVE
  To assess the association of socioeconomic deprivation (SED) with survival after stroke in China.
  
  
  METHODS
  A systematic literature review and a new population-based cohort study.
  
  
  METHODS
  In urban and rural communities in Anhui, China, 2978 residents aged ≥60 years took part in baseline investigation and were followed up for 5 years; five published studies were identified for a systematic review.
  
  
  METHODS
  167 of 2978 participants (5.6%) had doctor-diagnosed stroke at baseline or 1 year later. All-cause mortality in the follow-up.
  
  
  RESULTS
  In the Anhui cohort follow-up of 167 patients with stroke, 64 (38.3%) died. Multivariate adjusted hazard ratio (HR) of mortality in patients with educational level of less than or equal to primary school was 1.88 (95% CI 1.05 to 3.36) compared to those having more than primary school education. Increased HR of mortality in patients living in a rural area was at borderline significant (1.64, 0.97 to 2.78), but the HR in patients with lower levels of occupation and income was not significant. Published studies showed a significant increase in stroke mortality in relation to some SED indicators. Pooled relative risk (RR) of mortality in patients with low education was 3.07 (1.27 to 7.34), in patients with low income 1.58 (1.50 to 1.65) and in patients living in rural areas 1.47 (1.37 to 1.58).
  
  
  CONCLUSIONS
  The evidence suggests the presence of a mortality gradient after stroke for material as well as social forms of deprivation in China. Inequalities in survival after stroke persist and need to be taken into account when implementing intervention programmes.
authors: School of Health Administration, Anhui Medical University, Hefei, China Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK.
authors: Ruoling
authors: R
authors: Chen
authors: School of Health Administration, Anhui Medical University, Hefei, China.
authors: Zhi
authors: Z
authors: Hu
authors: Institute for Science and Technology in Medicine, Keele University, Keele, UK.
authors: Ruo-Li
authors: RL
authors: Chen
authors: School of Health Administration, Anhui Medical University, Hefei, China Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK.
authors: Dongmei
authors: D
authors: Zhang
authors: School of Health Administration, Anhui Medical University, Hefei, China.
authors: Long
authors: L
authors: Xu
authors: School of Health Administration, Anhui Medical University, Hefei, China.
authors: Jingjing
authors: J
authors: Wang
authors: Department of Practice and Policy, School of Pharmacy, University College London, UK.
authors: Li
authors: L
authors: Wei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis
keywords: SOCIAL MEDICINE
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