Published Online
on October 23, 2003

A more recent version of this article appeared on November 1, 2003

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Submitted on July 1, 2003
Accepted on July 18, 2003

Effect of Area-Based Deprivation on the Severity, Subtype, and Outcome of Ischemic Stroke

Stella Aslanyan MD^*; Christopher J. Weir PhD; Kennedy R. Lees MD, FRCP; John L. Reid DM, FRCP, FRSE; and Gordon T. McInnes MD, FRCP, FFPM

From the Division of Cardiovascular and Medical Sciences (S.A., C.J.W., K.R.L., J.L.R., G.T.M.) and Robertson Centre for Biostatistics (C.J.W.), University of Glasgow, Glasgow, UK.

^* To whom correspondence should be addressed. E-mail: 0110768a{at}student.gla.ac.uk.

Background and Purpose--Markers of low socioeconomic status (deprivation) are associated with stroke and its causes. In the United Kingdom, area-based deprivation measures are available routinely through links with postal codes. We hypothesized that deprivation is associated with ischemic stroke risk factors, severity, subtype, and outcome.

Methods--We studied 2026 patients, each with at least 2 years of outcome follow-up by record linkage after first admission with ischemic stroke to an acute stroke unit. Baseline factors recorded routinely were age, sex, medical history, blood pressure, and stroke severity and subtype. Deprivation was assessed by the Womersley score (WS) and Murray score (MS).

Results--Higher WS and MS were associated with stroke at younger age (eg, WS linear regression coefficient (r)=-0.26; 95% confidence interval [CI], -0.51 to -0.01 per additional point), smoking (odds ratio [OR], 1.12; 95% CI, 1.08 to 1.17), and claudication (OR, 1.09; 95% CI, 1.01 to 1.17); WS was associated with higher systolic blood pressure (r=0.13; 95% CI, 0.02 to 0.24); and MS was associated with severe stroke. Deprivation was not associated with case fatality in univariate analysis or after correction for all baseline factors. Deprivation was associated with readmission to hospital as a result of any vascular event in univariate analysis (hazard ratio [HR], 1.05; 95% CI, 1.02 to 1.09) and after correction for all baseline factors (HR, 1.06; 95% CI, 1.02 to 1.10).

Conclusions--Tackling health inequalities in stroke should focus on stroke primary prevention by tackling deprivation, including promoting changes in lifestyle.

Key words: deprivation • outcome • stroke, ischemic

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