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Authors of a Dutch study suggest that more community based healthcare programmes should be developed for stroke patients of lower socioeconomic status, who have more long term disability and handicap, even though they seemed to have received equal care.
Disability and handicap among all patients was high—601% and 59% respectively—but for patients grouped according to their socioeconomic status, both were significantly higher among the lower socioeconomic group, and significantly more in this group were in nursing homes. They were likely to have more disability up to three years after their stroke and handicap up to five years afterwards, after adjustment for demographic and clinical profiles. However, patients in the lower socioeconomic group were not significantly more likely to use any of the healthcare services more or less. Nevertheless the authors still claim some detrimental effect and argue for more coordination of community services for this group.
The prospective study included 465 patients admitted with stroke six months before to 23 hospitals in the Netherlands and entered into a study of quality of care. They were followed up for five years. Data on outcomes and use of healthcare services were derived from interviews with patients or carers at six months, three years, and five years after their stroke. Educational level determined socioeconomic status.
Low socioeconomic status carries an increased risk of stroke, of death after a stroke, and poor recovery of function, but its effects on long term outcome and use of healthcare services are less clear.
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