London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 313 66 Stroke prognosis Socioeconomic Deprivation and Survival after Stroke: Findings from the Prospective South London Stroke Register of 1995-2011 R. Chen1, C.J. McKevitt2, A.G. Rudd3, C.D.A. Wolfe4 King’s College London, London, UNITED KINGDOM1, King’s College London, London, UNITED KINGDOM2, King’s College London, London, UNITED KINGDOM3, King’s College London, London, UNITED KINGDOM4 Background Associations between socioeconomic deprivation (SED) and survival after stroke are inconsistent, and the long-term impact of SED on survival is unclear. The impact is not entirely known for black and minority ethnic people living in high income countries. Methods We analysed data from 4398 patients (3103 Whites, 932 Blacks, 253 Asians) with first-ev-er stroke, collected by a population-based stroke register in South London, UK from 1995 to 2011. SED was measured using the Carstairs deprivation index (the higher score, the more deprived) and analysed in its sextitles for all patients, and then in the quartitle within each of 3 ethnic groups. The impact of SED on mortality was examined in multivariate Cox regression models. Results During 17 years follow up 2,754 patients died. Patients with the 6th versus 1st sextile of Carstairs score had a significant increase in 3-month mortality (Table 1), and in 17-year mortality (adjusted hazard ratio (HR) 1.16, 95%CI 1.01-1.32). The increased HR was significant in white pa-tients only. However, the data for the 4th versus 1st quartile of Carstairs score showed that while the HR increased not significantly in Whites (eg, 1.13, 0.93-1.36 for 3-month mortality), Blacks with SED had a significant increase in 3-month and 1-year mortality but not in >2 years follow up, and Asians had similar patterns of increased HRs with borderline significance (Table 2). Asians in the 3rd versus all 1st and 2nd tertile of Carstairs score had a multivariate adjusted HR of 1.80 (1.01- 3.21) for 2-year mortality. Further adjustment for hospital care attenuated the HRs in Blacks and Asians, but did not substantially change in those for Whites (Table 1). Conclusions Stroke survival inequalities may exist in England. The Blacks and Asians had short-term impact of SED on survival, which was stronger than Whites, while Whites had both short and long term impacts. Further efforts are required to achieve equality in survival among stroke patients. Table 1. Number* and adjusted HR† of mortality among stroke patients across 6 groups of the Carstairs score: SLSR of 1995-2011 Duration of follow up 3 months 5 years different SED Death (%) HR† (95%CI) Death (%) HR† (95%CI) Sextile SED S-1 181 (24.4) 1.00 363 (50.1) 1.00 S-2 178 (24.9) 1.14 (0.93-1.41) 364 (51.9) 1.10 (0.95-1.28) S-3 189 (25.9) 0.99 (0.80-1.22) 376 (52.4) 1.00 (0.86-1.16) S-4 204 (28.0) 1.18 (0.96-1.45) 382 (53.9) 1.13 (0.98-1.31) S-5 184 (25.0) 1.01 (0.82-1.24) 377 (52.2) 1.10 (0.95-1.28) S-6 # 198 (27.8) 1.29 (1.05-1.58) 348 (50.5) 1.14 (0.99-1.33) * the number of patients at the follow up time were derived from those who were actually followed up to the time, including deaths. † adjusted for age, sex, ethnicity, years of stroke occurring, location of hospital admission, living conditions before stroke, cardiovascular risk factors score, type of stroke, Glasgow coma, speech deficit and motor deficit. # corresponding HRs for 3-month and 5-year mortality in Whites were 1.37 (1.08-1.73) and 1.21 (1.02-1.44), and in the groups of Blacks and Asians 1.32 (0.79-2.21) and 1.00 (0.72-1.40) Table 2. Number* and adjusted HR† of mortality among stroke patients across 4 groups of the Carstairs score within each ethnicity: SLSR of 1995-2011 Duration of follow up Patient with 3 months 1 year different SED Death (%) HR† (95%CI) Death (%) HR† (95%CI) Black Quartile SED Q-1 31 (13.2) 1.00 45 (19.7) 1.00 Q-2 35 (15.6) 1.19 (0.69-2.06) 46 (21.1) 1.16 (0.74-1.83) Q-3 39 (17.0) 1.40 (0.84-2.32) 51 (23.3) 1.39 (0.91-2.13) Q-4 41 (18.1) 1.76 (1.06-2.94) 50 (24.2) 1.54 (1.00-2.37) Asian Quartile SED Q-1 14 (21.9) 1.00 17 (26.6) 1.00 Q-2 8 (12.3) 0.93 (0.31-2.81) 11 (17.7) 0.91 (0.35-2.31) Q-3 13 (21.3) 1.75 (0.65-4.76) 15 (24.6) 1.50 (0.63-3.58) Q-4 10 (16.1) 1.33 (0.43-4.09) 15 (24.6) 1.80 (0.72-4.48) * the number of patients at the follow up time were derived from those who were actually followed up to the time, including deaths. † adjusted for age, sex, ethnicity, years of stroke occurring, location of hospital admission, living conditions before stroke, cardiovascular risk factors score, type of stroke, Glasgow coma, speech deficit and motor deficit.
Karger_ESC London_2013
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