Stroke outcomes in a socio-economically disadvantaged urban community

Abstract

Aims: To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources.

Methods: Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded.

Results: The study included 196 patients. Median age was 60 (IQR 51-69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3-12) and median mRS 4 (IQR 3-5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79-0.96, p < 0.0001) and disability (mRS OR 2.34, 95%CI 1.20-4.54, p < 0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95% CI 1.22-9.59, p = 0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months.

Conclusion: Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes.