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. 2023 Aug;54(8):2040-2049.
doi: 10.1161/STROKEAHA.123.043547. Epub 2023 Jun 28.

Socioeconomic Inequalities in Functional Outcome After Reperfusion-Treated Ischemic Stroke

Sine Mette Øgendahl Buus  1 , Marie Louise Schmitz  1 , Pia Cordsen  2 , Søren Paaske Johnsen  2 , Grethe Andersen  1   3 , Claus Ziegler Simonsen  1   3
Affiliations

Socioeconomic Inequalities in Functional Outcome After Reperfusion-Treated Ischemic Stroke

Sine Mette Øgendahl Buus et al. Stroke. 2023 Aug.

Abstract

Background: We aimed to investigate whether socioeconomic status (SES) was associated with functional outcome in patients with ischemic stroke treated with reperfusion therapy (intravenous thrombolysis and/or thrombectomy).

Methods: This nationwide cohort study included reperfusion-treated patients with ischemic stroke ≥18 years registered in the Danish Stroke Registry between 2015 and 2018. Functional outcome was determined by the modified Rankin Scale score 90 days after stroke. SES was defined by educational attainment, family income, and employment status before stroke. SES data were available from Statistics Denmark and linked on the individual level with data from the Danish Stroke Registry. Uni- and multivariable ordinal logistic regression was performed for each socioeconomic parameter individually (education, income, and employment) to estimate the common odds ratios (cORs) for lower 90-day modified Rankin Scale scores.

Results: A total of 5666 patients were included. Mean age was 68.7 years (95% CI, 68.3-69.0), and 38.4% were female. Low SES was associated with lower odds for achieving lower 90-day modified Rankin Scale score: Low versus high education, cOR, 0.69 (95% CI, 0.61-0.79), low versus high income, cOR, 0.59 (95% CI, 0.53-0.67), and unemployed versus employed, cOR, 0.70 (95% CI, 0.58-0.83). Inequalities were reduced after adjusting for age, sex, and immigrant status, except for unemployed versus employed patients, adjusted cOR, 0.66 (95% CI, 0.54-0.80). No statistically significant differences remained after adjusting for potentially mediating variables (eg, stroke severity, prestroke modified Rankin Scale, and smoking).

Conclusions: Socioeconomic inequalities were observed in functional outcome after reperfusion treated ischemic stroke. In particular, prestroke unemployment was negatively associated with good functional outcome. A more adverse prognostic profile among patients with low SES appeared to explain the majority of these inequalities.

Keywords: activities of daily living; healthcare disparities; ischemic stroke; socioeconomic factors; stroke rehabilitation; thrombectomy; tissue-type plasminogen activator.

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Conflict of interest statement

Disclosures Dr Bus reports grants from Helsefonden, TrygFonden, Aase og Ejnar Danielsens Fond, and grants from Aarhus University Department of Clinical Medicine. Dr Simonsen reports research grants from Novo Nordisk Foundation and Health Research Foundation of Central Denmark Region. Dr Johnsen reports compensation from Pfizer for consultant services, compensation from Bristol-Myers Squibb for consultant services, grants from Pfizer, grants from Novo Nordisk, and grants from TrygFonden. The other authors report no conflicts.

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