The association between socioeconomic status and disability after stroke: Findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry

BMC Public Health

Eric D Peterson¹  Linda S Williams³  Wenqin Pan¹  Louise Zimmer¹  Cheryl Bushnell⁴  Xin Zhao¹  Janet Prvu Bettger² 

[1] Duke Clinical Research Institute, Durham, NC 27710, USA;Duke School of Nursing and Duke Clinical Research Institute, 307 Trent Drive, 511 DUMC 3322, Durham, NC 27710, USA;Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA;Wake Forest Baptist Medical Center, Winston-Salem, NC, USA

关键词: Outcomes research;    Socioeconomic position;    Disability;    Recovery;    Ischemic stroke;   

Others  :  1131815
DOI  :  10.1186/1471-2458-14-281

 received in 2013-06-19, accepted in 2014-03-17,  发布年份 2014

【 摘 要 】

Background

Stroke is the leading cause of disability among adults in the United States. The association of patients’ pre-event socioeconomic status (SES) with post-stroke disability is not well understood. We examined the association of three indicators of SES—educational attainment, working status, and perceived adequacy of household income—with disability 3-months following an acute ischemic stroke.

Methods

We conducted retrospective analyses of a prospective cohort of 1965 ischemic stroke patients who survived to 3 months in the Adherence eValuation After Ischemic stroke – Longitudinal (AVAIL) study. Multivariable logistic regression was used to examine the relationship of level of education, pre-stroke work status, and perceived adequacy of household income with disability (defined as a modified Rankin Scale of 3–5 indicating activities of daily living limitations or constant care required).

Results

Overall, 58% of AVAIL stroke patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. After adjusting for demographic and clinical factors, stroke survivors who were unemployed or homemakers, disabled and not-working, retired, less educated, or reported to have inadequate income prior to their stroke had a significantly higher odds of post-stroke disability.

Conclusions

In this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke. The results may have implications for public health and health service interventions targeting stroke survivors at risk of poor outcomes.

【 授权许可】

   
2014 Prvu Bettger et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER III, Moy CS, et al.: Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014, 123:e18-e209.
• [2]Hong KS, Saver JL: Years of disability-adjusted life gained as a result of thrombolytic therapy for acute ischemic stroke. Stroke 2010, 41(3):471-477.
• [3]Ickovics JR, Viscoli CM, Horwitz RI: Functional recovery after myocardial infarction in men: the independent effects of social class. Ann Intern Med 1997, 127:518-525.
• [4]Addo J, Ayerbe L, Mohan KM, Crichton S, Sheldenkar A, Chen R, Wolfe CD, McKevitt C: Socioeconomic status and stroke: an updated review. Stroke 2012, 43(4):1186-1191.
• [5]LaBresh KA, Reeves MJ, Frankel MR, Albright D, Schwamm LH: Hospital treatment of patients with ischemic stroke or transient ischemic attack using the “Get With The Guidelines” program. Arch Intern Med 2008, 168(4):411-417.
• [6]Bushnell C, Zimmer L, Schwamm L, Goldstein LB, Clapp-Channing N, Harding T, Drew L, Zhao X, Peterson E: The Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) registry: design, rationale, and baseline patient characteristics. Am Heart J 2009, 157(3):428-435. e422
• [7]Reeves MJ, Fonarow GC, Zhao X, Smith EE, Schwamm LH: Quality of care in women with ischemic stroke in the GWTG program. Stroke 2009, 40(4):1127-1133.
• [8]Schwamm LH, Fonarow GC, Reeves MJ, Pan W, Frankel MR, Smith EE, Ellrodt G, Cannon CP, Liang L, Peterson E, Labresh KA: Get with the guidelines-stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation 2009, 119(1):107-115.
• [9]Nederhof AJ: Methods of coping with social desirability bias: a review. Eur J Soc Psychol 1985, 15(3):263-280.
• [10]Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S: Socioeconomic status in health research: one size does not fit all. JAMA 2005, 294(22):2879-2888.
• [11]Miller DK, Malmstrom TK, Joshi S, Andresen EM, Morley JE FDW: Clinically relevant levels of depressive symptoms in community-dwelling middle-aged African Americans. J Am Geriatr Soc 2004, 52(5):741-748.
• [12]Duncan PW, Lai SM, Keighley J: Defining post-stroke recovery: implications for design and interpretation of drug trials. Neuropharmacology 2000, 39(5):835-841.
• [13]Rey V, Faouzi M, Huchmand-Zadeh M, Michel P: Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland. Eur J Neurol 2011, 18(8):1094-1097.
• [14]Putman K, De Wit L, Schoonacker M, Baert I, Beyens H, Brinkmann N, Dejaeger E, De Meyer AM, De Weerdt W, Feys H, Jenni W, Kaske C, Leys M, Lincoln N, Schuback B, Schupp W, Smith B, Louckx F: Effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study. J Neurol Neurosurg Psychiatry 2007, 78(6):593-599.
• [15]Jakovljevic D, Sarti C, Sivenius J, Torppa J, Mahonen M, Immonen-Raiha P, Kaarsalo E, Alhainen K, Kuulasmaa K, Tuomilehto J, Puska P, Salomaa V: Socioeconomic status and ischemic stroke: The FINMONICA Stroke Register. Stroke 2001, 32(7):1492-1498.
• [16]van den Bos GA, Smits JP, Westert GP, van Straten A: Socioeconomic variations in the course of stroke: unequal health outcomes, equal care? J Epidemiol Community Health 2002, 56(12):943-948.
• [17]Grube MM, Koennecke HC, Walter G, Thummler J, Meisel A, Wellwood I, Heuschmann PU: Association between socioeconomic status and functional impairment 3 months after ischemic stroke: the Berlin Stroke Register. Stroke 2012, 43(12):3325-3330.
• [18]Reeves MJ, Vaidya RS, Fonarow GC, Liang L, Smith EE, Matulonis R, Olson DM, Schwamm LH: Quality of care and outcomes in patients with diabetes hospitalized with ischemic stroke: findings from get with the guidelines-stroke. Stroke 2010, 41(5):e409-e417.
• [19]Schwamm LH, Reeves MJ, Pan W, Smith EE, Frankel MR, Olson D, Zhao X, Peterson E, Fonarow GC: Race/ethnicity, quality of care, and outcomes in ischemic stroke. Circulation 2010, 121(13):1492-1501.
• [20]Cumbler E, Murphy P, Jones WJ, Wald HL, Kutner JS, Smith DB: Quality of care for in-hospital stroke: analysis of a statewide registry. Stroke 2011, 42(1):207-210.
• [21]Reeves MJ, Grau-Sepulveda MV, Fonarow GC, Olson DM, Smith EE, Schwamm LH: Are quality improvements in the get with the guidelines: stroke program related to better care or better data documentation? Circ Cardiovasc Qual Outcomes 2011, 4(5):503-511.
• [22]Reeves MJ, Fonarow GC, Smith EE, Pan W, Olson D, Hernandez AF, Peterson ED, Schwamm LH: Representativeness of the get with the guidelines-stroke registry: comparison of patient and hospital characteristics among Medicare beneficiaries hospitalized with ischemic stroke. Stroke 2012, 43(1):44-49.