Article Text

other Versions

PDF
Research paper
Mortality following stroke during and after acute care according to neighbourhood deprivation: a disease registry study
  1. Olivier Grimaud1,2,
  2. Emmanuelle Leray1,
  3. Benoit Lalloué1,
  4. Radouane Aghzaf1,
  5. Jérôme Durier3,
  6. Maurice Giroud3,
  7. Yannick Béjot3
  1. 1French School of Public Health (EHESP), Rennes, France
  2. 2INSERM U707, Research Group on the Social Determinants of Health and Healthcare, UPMC, Univ Paris 6, Paris, France
  3. 3Department of Neurology, Dijon Stroke Registry, EA 4184, University Hospital and Medical School of Dijon, Dijon, France
  1. Correspondence to Dr Olivier Grimaud, EHESP, Avenue du Pr Léon Bernard, Rennes 35043, France; olivier.grimaud{at}ehesp.fr

Abstract

Background Neighbourhood deprivation has been shown to be inversely associated with mortality 1 month after stroke. Whether this disadvantage begins while patients are still receiving acute care is unclear. We aimed to study mortality after stroke specifically in the period while patients are under acute care and the ensuing period when they are discharged to home or other care settings.

Methods Our sample includes 1760 incident strokes (mean age 75, 48% men, 86% ischaemic) identified between 1998 and 2010 by the population-based stroke registry of Dijon (France). We used Cox regression to study all-cause mortality up to 90 days after stroke occurrence.

Results Overall, 284 (16.1%) patients died during the 90 days following stroke. Prior to stroke, risk factors prevalence (eg, high blood pressure and diabetes) and acute care management did not vary across deprivation levels. There was no association between deprivation and mortality while patients were in acute care (HR comparing the highest to the lowest tertiles of deprivation: 1.01, 95% CI 0.71 to 1.43). After discharge, however, age and gender adjusted mortality gradually increased with deprivation (HR 2.08, 95% CI 1.07 to 4.02). This association was not modified when stroke type and severity were accounted for.

Conclusions The gradient of higher poststroke mortality with increasing neighbourhood deprivation was noticeable only after acute hospital discharge. Quality of postacute care and social support are potential determinants of these variations.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.