title: Association between socioeconomic deprivation and functional impairment after stroke: the South London Stroke Register.
abstract: OBJECTIVE
  Previous findings of the association between socioeconomic deprivation and functional impairment after stroke are inconsistent. There is a lack of data on long-term association. We assessed the association and differences by age, sex, prestroke comorbidities, and stroke phenotypes.
  
  
  METHODS
  We examined data from the South London Stroke Register cohort of 1995 to 2011, recording all first-ever strokes in patients of all ages in South London. A total of 2104 patients were alive at 3 months after stroke. Socioeconomic deprivation was measured using the index of multiple deprivation based on patient postcodes, and functional impairment after stroke was defined as a Barthel index of <15.
  
  
  RESULTS
  At 3 months after stroke, 643 patients had functional impairment (30.6%; 95% confidence interval, 28.6%-32.5%). Compared with the first quartile of index of multiple deprivation (the least deprived), multivariate-adjusted odds ratios for functional impairment in patients with the second, third, and fourth quartiles were 1.29 (95% confidence interval, 0.94-1.76), 1.33 (0.97-1.82), and 1.78 (1.31-2.43), overall P=0.004. The association was significant in patients aged ≥65 years (corresponding odds ratios were 1.49 [1.02-2.17], 1.21 [0.83-1.75], and 1.94 [1.34-2.81]; P=0.003); in women, P=0.008, in patients who do not have prestroke comorbidities, P=0.009, and in patients with ischemic stroke, P<0.001, but not significant in their counterpart patients. There were similar patterns of the associations of socioeconomic deprivation with impairment at 3 years after stroke.
  
  
  CONCLUSIONS
  There are significant inequalities in short- and long-term functional recovery after stroke. General socioeconomic improvement, targeting groups at high risk of functional impairment is likely to reduce inequality in functional recovery after stroke.
authors: From the Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, United Kingdom (R.C., S.C., C.M., A.G.R., A.S., C.D.A.W.); and National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom (A.G.R., C.D.A.W.). ruoling.chen@kcl.ac.uk.
authors: Ruoling
authors: R
authors: Chen
authors: From the Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, United Kingdom (R.C., S.C., C.M., A.G.R., A.S., C.D.A.W.); and National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom (A.G.R., C.D.A.W.).
authors: Siobhan
authors: S
authors: Crichton
authors: From the Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, United Kingdom (R.C., S.C., C.M., A.G.R., A.S., C.D.A.W.); and National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom (A.G.R., C.D.A.W.).
authors: Christopher
authors: C
authors: McKevitt
authors: From the Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, United Kingdom (R.C., S.C., C.M., A.G.R., A.S., C.D.A.W.); and National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom (A.G.R., C.D.A.W.).
authors: Anthony G
authors: AG
authors: Rudd
authors: From the Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, United Kingdom (R.C., S.C., C.M., A.G.R., A.S., C.D.A.W.); and National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom (A.G.R., C.D.A.W.).
authors: Anita
authors: A
authors: Sheldenkar
authors: From the Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, United Kingdom (R.C., S.C., C.M., A.G.R., A.S., C.D.A.W.); and National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom (A.G.R., C.D.A.W.).
authors: Charles D A
authors: CD
authors: Wolfe
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010641:Phenotype; D011203:Poverty; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D000071939:Stroke Rehabilitation
keywords: comorbidity; epidemiology; hemorrhage; ischemia; sex; socioeconomic status; stroke recovery