Social inequalities and gender differences in healthcare management of acute ischaemic stroke in France. (21st July 2022)

• Record Type: Journal Article
• Authors: Naouri, Diane; Allain, Samuel; Fery‐Lemonier, Elisabeth; Wolff, Valérie; Derex, Laurent; Raynaud, Philippe; Costemalle, Vianney
• Is Part Of: European journal of neurology. Volume 29:Number 11(2022)
• Page Start: 3255
• Page End: 3263
• Publication Date: 2022-07-21
• Subjects: healthcare organization -- health services research -- inequalities in health -- stroke; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.15490
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background and purpose: There are regional disparities in access to stroke units in France. Several studies have shown that living in disadvantaged areas is associated with a higher frequency of stroke, worse severity at presentation, increased level of dependency and higher mortality rates. However, few studies have explored the association between an individual's socioeconomic characteristics and stroke care. Our study aimed to determine if living standards are associated with stroke unit access for patients admitted to hospital for acute ischaemic stroke. Methods: Using the EDP‐Santé French administrative database, all patients admitted to hospital for acute ischaemic stroke between 2014 and 2017 were selected. Acute ischaemic stroke corresponded to hospital stay with International Classification of Diseases 10th Revision codes I63 or I64 as the main diagnosis. Multivariate logistic regression was used to identify if standard of living was associated with likelihood of admission to a stroke unit. Results: In all, 14, 123 acute care episodes were identified, corresponding to 335, 273 episodes in the general population when appropriately weighted. Of these, 52.9% were admitted to a stroke unit. Being in the first (i.e., poorest) living standard quartile was associated with lower likelihood of admission to a stroke unit compared with the fourth (i.e., wealthiest) quartile, and was associated with a higher likelihood of paralysis and language disorder, and death at 1 year. Conclusion: A low living standard was associated with lower likelihood of admission to a stroke unit as well as a greater chance of paralysis and aphasia at the end of hospitalization and a higher possibility of death at 1 year after stroke. Greater access to stroke units for disadvantaged people should be promoted. Abstract : Using the EDP‐Santé French administrative database, between 2014 and 2017, it was found that a low living standard was associated with lower likelihood of admission to a stroke unit as well as a greater risk of paralysis and aphasia at the end of hospitalization and a higher risk of death at 1 year after stroke. Greater access to stroke units for disadvantaged people should be promoted.