The influence of individual socioeconomic status on the clinical outcomes in ischemic stroke patients with different neighborhood status in Shanghai, China

Abstract

Objective: Socioeconomic status (SES) is being recognized as an important factor in both social and medical problems. The aim of present study is to examine the relationship between SES and ischemic stroke and investigate whether SES is a predictor of clinical outcomes among patients with different neighborhood status from Shanghai, China. Methods: A total of 471 first-ever ischemic stroke patients aged 18-80 years were enrolled in this retrospective study. The personal SES of each patient was evaluated using a summed score derived from his or her educational level, household income, occupation, and medical reimbursement rate. Clinical adverse events and all-cause mortality were analyzed to determine whether SES was a prognostic factor, its prognostic impact was then assessed based on different neighborhood status using multivariable Cox proportional hazard models after adjusting for other covariates. Results: The individual SES showed a significant positive correlation with neighborhood status (r = 0.370; P < 0.001). The incidence of clinical adverse events and mortality were significantly higher in low SES patients compared with middle and high SES patients (P = 0.001 and P = 0.037, respectively). After adjusting other risk factors and neighborhood status, Kaplan-Meier analysis showed clinical adverse events and deaths were still higher in the low SES patients (all P < 0.05). Multivariate Cox regression analysis demonstrated that both personal SES and neighborhood status are independent prognostic factors for ischemic stroke (all P < 0.05). Besides, among patients with low and middle neighborhood status, lower individual SES was significantly associated with clinical adverse events and mortality (all P < 0.05). Conclusion: Both individual SES and neighborhood status are significantly associated with the prognosis after ischemic stroke. A lower personal SES as well as poorer neighborhood status may significantly increase risk for adverse clinical outcomes among ischemic stroke patients.

Keywords: China; Health inequality; Ischemic stroke; Neighborhood status; Socioeconomic status; Survival..

Figure 1

Distribution of individual SES scores among the enrolled 471 study population. SES, socioeconomic status.

Figure 2

Multivariable adjusted survival curves for clinical adverse events according to individual SES tertiles. (A) Adjusted for age, gender and cardiovascular risk factors. (B) Adjusted for age, gender, cardiovascular risks, education, income, occupation, medical insurance reimbursement and neighborhood status. Cardiovascular risk factors include CHD, hypertension, diabetes mellitus, lipid disorders and smoking. SES, socioeconomic status; CHD, coronary heart disease.

Figure 3

Multivariable adjusted survival curves for all-cause mortality according to individual SES tertiles. (A) Adjusted for age, gender and cardiovascular risk factors. (B) Adjusted for age, gender, cardiovascular risks, education, income, occupation, medical insurance reimbursement and neighborhood status. Cardiovascular risk factors include CHD, hypertension, diabetes mellitus, lipid disorders and smoking. SES, socioeconomic status; CHD, coronary heart disease.

Figure 4

Adjusted HRs for clinical adverse events and all-cause mortality of ischemic stroke patients. (A) Multivariate Cox regression analysis demonstrated both individual SES and neighborhood status are independent correlated of clinical adverse events. (B) Multivariate Cox regression analysis revealed that age, individual SES and neighborhood status are all important predictors for all-cause mortality in ischemic stroke. HR, hazard ratio; SES, socioeconomic status; CHD, coronary heart disease.