London, United Kingdom 2013 9 Stroke prognosis Socioeconomic disparities in stroke case fatality – Observations from Riks-Stroke, the Swedish stroke register A. Lindmark1, E.-L. Glader2, K. Asplund3, B. Norrving4, M. Eriksson5 Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, SWEDEN1, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SWE-DEN2, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SWEDEN3, Department of Clinical Sciences, Section of Neurology, Lund University, Lund, SWEDEN4, Depart-ment of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, SWEDEN5 Background: Low socioeconomic status (low education and income level) has been found to be as-sociated with increased stroke mortality, however, findings from previous studies on the association between socioeconomic status and case fatality (survival) after stroke have been inconsistent. We have explored the association between socioeconomic status and survival after stroke using Riks- Stroke, the Swedish Stroke Register, emphasizing changes in survival (in)equality with time after stroke. Methods: All 76 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. Riks-Stroke data on 18-74 year old patients with onset of first stroke during the years 2001-2009 were combined with data from other official Swedish registers. Case fatality was analyzed by socio-economic status (education, income, country of birth and cohabitation) and other patient characteris-tics. E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 225 Results: Of the 62 497 patients in the study a total of 6 094 (9.8 %) died within the first year af-ter stroke. Low income, primary school education and living alone were independent predictors of higher case fatality after the acute phase. Differences related to income and cohabitation were pres-ent early, at 8-28 days after stroke, and the gaps expanded thereafter. The association between edu-cation and case fatality was not present until 29 days-1 year after stroke. Dissimilarities in secondary preventative medications prescribed on discharge from hospital had only a minor impact on these differences. Conclusion: Socioeconomic status had limited effect on acute phase case fatality, indicating minor disparities in acute stroke treatment. Survival inequality, present already in the subacute phase, in-creased markedly over time since the stroke event. The socioeconomic differences could not be ex-plained by differences in secondary prevention at discharge from hospital. Large socioeconomic dif-ferences in long-term survival after stroke may also exist in a country with limited income inequity. 8 Stroke prognosis Impact of blood biomarkers on long term risk of recurrent vascular events after TIA/isch-aemic stroke: results of a age-stratified analysis S. Greisenegger1, H.C. Segal2, A.I. Burgess3, D.L. Poole4, Z. Mehta5, P.M. Rothwell6 Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, Universi-ty of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM1, Stroke Prevention Re-search Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM2, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KING-DOM3, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM4, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM5, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, UNITED KINGDOM6 BACKGROUND: Studies of the usefulness of blood-biomarkers in predicting recurrent vascular events after TIA and ischaemic stroke have been conflicting. However, although analyses are often adjusted for age, few studies have stratified analyses by age in order to determine whether the pre-dictive value of biomarkers changes with age. We performed an age-stratified analysis of the impact of biomarkers on risk of recurrent vascular events. METHODS: We analysed 10 standard inflammatory or haemostatic biomarkers in consecutive el-igible patients with TIA or ischaemic stroke in a population-based study (Oxford Vascular Study). Patients were recruited from 2002-7 and followed-up to 2012. Associations between biomarkers (tertiles) and risk of recurrent stroke, MI and vascular death were determined by Cox regression (ad-justed for age and sex) in all patients and stratified by age (above vs below 65 years). RESULTS: Of 1217 patients (median age 75.5; 52% female), 288 (23.7%) were ≤ 65 years. During about 5000 patient-years of follow-up there were 250 first recurrent vascular events. Four biomarkers (fibrinogen, P-selectin, neutrophil gelatinase associated lipocalin and interleukin-6) were significantly predictive of recurrent events after adjustment for age and sex, but without stratification by age. P-selectin was most predictive of recurrent events at age <65 years (HR for highest vs low-est tertile: 3.74, 1.33-10.53, p=0.012) and interleukin-6 was most predictive at >65 years (HR 2.23, 1.34-3.73, p=0.002), but for none of the biomarkers was there a statistically significant interaction between age and predictive value. CONCLUSION: Some inflammatory and haemostatic biomarkers predicted risk of recurrent vascu-lar events, but prognostic value did not appear to differ substantially in relation to age.
Karger_ESC London_2013
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