Socioeconomic Status and Transient Ischaemic Attack/Stroke: A Prospective Observational Study

• Published in: Cerebrovascular diseases (Basel, Switzerland) Vol. 31; no. 2; pp. 130 - 137
• Main Authors: Kerr, Gillian D., Higgins, Peter, Walters, Matthew, Ghosh, Sandip K., Wright, Fiona, Langhorne, Peter, Stott, David J.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2011
• Subjects: Age Factors; Aged; Aged, 80 and over; Chi-Square Distribution; Comorbidity; Disability Evaluation; Female; Health Services - utilization; Health Services Accessibility - statistics & numerical data; Hospitals - statistics & numerical data; Humans; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - epidemiology; Linear Models; Logistic Models; Male; Middle Aged; Odds Ratio; Original Paper; Prevalence; Prospective Studies; Risk Assessment; Risk Factors; Scotland - epidemiology; Severity of Illness Index; Smoking - epidemiology; Socioeconomic Factors; Stroke - diagnosis; Stroke - epidemiology; Time Factors; Vascular Diseases - epidemiology; Scotland; Stroke; Socioeconomic status; Transient ischaemic attack; Health care access; Cigarette smoking; Vascular risk factors; Co-morbidity
• ISSN: 1015-9770; 1421-9786
• DOI: 10.1159/000321732

Background: Lower socioeconomic status (SES) is associated with an increased risk of stroke but the mechanisms are unclear. We aimed to determine whether low-SES stroke/transient ischaemic attack (TIA) patients have a greater burden of vascular risk factors/co-morbidity and reduced health care access. Methods: We prospectively studied 467 consecutive stroke and TIA patients from 3 Scottish hospitals (outpatients and inpatients) during 2007/2008. We recorded vascular risk factors, stroke severity, co-morbidity measures, investigations and health service utilisation. SES was derived from postcodes using Scottish Neighbourhood Statistics and analysed in quartiles. Results: TIA/stroke patients in the lowest SES quartile were younger (64 years, SD 14.1) than those in the highest quartile (72 years, SD 12.9; p < 0.0001). They were more likely to be current smokers (42 vs. 22%; p = 0.001) but there was no association with other vascular risk factors/co-morbidity. There was a trend for those with lower SES to have a more severe stroke [modified National Institutes of Health Stroke Scale score and interquartile range: 4 (2–6) vs. 3 (1–5); multivariate p = 0.05]. Lower SES groups were less likely to have neuro-imaging (82 vs. 90%; p = 0.036) or an electrocardiogram (72 vs. 87%; p = 0.003), but differences were no longer significant on multivariate analysis. However, there was equal access to stroke unit care. Conclusions: Low-SES TIA and stroke patients are younger and have a more severe deficit; an increased prevalence of smoking is likely to be a major contributor. We found equal access to stroke unit care for low-SES patients.