Published Online
on December 23, 2004

A more recent version of this article appeared on February 1, 2005

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Submitted on July 8, 2004
Revised on August 12, 2004
Accepted on November 2, 2004

Are There Inequalities in the Provision of Stroke Care? Analysis of an Inner-City Stroke Register

Christopher McKevitt PhD^*; Catherine Coshall MSc; Kate Tilling PhD; and Charles Wolfe MD

From the Department of Public Health Sciences (C.M., C.C., C.W.), King’s College London; and the Department of Social Medicine, University of Bristol (K.T.), United Kingdom.

^* To whom correspondence should be addressed. E-mail: christopher.mckevitt{at}kcl.ac.uk.

Background and Purpose--There is evidence of unequal access to health care interventions even where universal health systems operate. We investigated associations between patients’ sociodemographic characteristics and the provision of acute and longer-term stroke care in a multiethnic urban population.

Methods--We used data from 1635 patients with first-ever stroke, collected by a population-based stroke register from 1995 to 2000. Using multivariable analyses, controlled for sociodemographic and clinical factors, we investigated access to 22 evidence-based components of care.

Results--1392 patients (85.1%) were admitted to hospital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with clinical need, 607 (70.7%) received physical therapies; 477 (59.8%) received speech and language therapy. Older age was associated with lower odds of hospitalization (odds ratio [OR], 0.50; 95% CI, 0.32 to 0.77, P=0.02) and diagnostic brain imaging (OR, 0.15; 95% CI, 0.08 to 0.30, P<0.01) but higher odds of receiving physical therapy (OR, 4.24; 95% CI, 1.22 to 14.73, P<0.01). Black ethnicity was associated with higher odds of stroke unit admission (OR, 1.59; 95% CI, 1.01 to 2.49, P<0.04). There was a weak association between socioeconomic status and admission to hospital and stroke unit. Gender was associated only with treatment of hypertension before stroke.

Conclusions--Provision of individual components of care over 1 year varied for specific sociodemographic categories, but there was no consistent pattern of inequality. Clinical decision-making processes are likely to influence these patterns. Further information about clinician and patient roles in decision making is required.

Key words: access to health care • socioeconomic factors • stroke

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